Presentation
P1+0 seeking another pregnancy.
Patient Data
Smooth fundal indentation of endometrial cavity. The intercornual distance 4.4 cm (> 4cm), fundal internal indentation depth 5.5 mm (<10 mm) and intercornual angle 140° (>90°), suggestive of arcuate uterus.
Normal opacification of both fallopian tubes down to their fimbrial ends with normal spill of contrast and peritoneal smearing in delayed film denoting patency.
Case Discussion
On ultrasound examination of the patient, there is normal fundal contour with no cleft. Hysterosalpingogram features support the diagnosis of arcuate uterus, which include wide intercornual distance (>4 cm), wide intercornual angle >90° and fundal internal indentation depth < 1 cm.
The differential diagnosis is bicornuate uterus, in which there is deep indentation below intercornual line (>10 mm) and also an intercornual distance of >4 cm. Differentiation will not be based on hysterosalpingogram and will be on modalities that show fundal myometrium above intercornual line like 3D ultrasonography and MRI that will show a deep fundal cleft ≤5 mm above the intercornual line in bicornuate uterus.
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