Findings: Y-shaped uterine cavity noted at time of hysterosalpingography. Filling defect in right cornu. No filling of the Fallopian tubes or evidence of peritoneal spillage.

Diagnosis: Septate uterus identified at time of open laparotomy for myomectomy. Persistent small fibroid in right uterine cornu. Bilateral tubal obstruction.

Discussion: The endometrial cavities of bicornuate and septate uteri can have identical or similar appearance at the time of hysterosalpingography. The only way to differentiate the two is to identify a muscular septum between the two uterine horns present in a bicornate uterus. Ultrasound examinations can frequently identify the septum. If this fails a laparoscopic examination can be used.

The difference is clinically significant in cases of infertility and miscarriage. Increased fetal loss in the second trimester or later is associated with a septate uterus. On the other hand the bircornuate uterus is thought to have little or no clinical effect on conception or implantation.

References:
Winfield AC, Fleisdner AC, Moore DE. Diagnostic Imaging of Fertility Disorder,
Current Problems in Diagnostic Radiology. Year Book Medical Publishers, Inc.
Jan/Feb 1990;19(1):20-21.

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