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Radiology Case Presentation by:Brad Moatz CC: 19-year-old female with right lower quadrant pain and vomiting. Uterine Anomalies Congenital anomalies of the uterus are often asymptomatic and therefore unrecognized The incidence of congenital uterine anomalies is difficult to determine since many women with such anomalies are not diagnosed, especially if they are asymptomatic. Uterine anomalies occur in 2 to 4 percent of fertile women with normal reproductive outcomes Septate/Arcuate Uterus ?A septate uterus has a normal external surface but two endometrial cavities The septate uterus develops from a defect in canalization or resorption of the midline septum between the two müllerian ducts. The degree of septation varies from a small midline septum to total failure in resorption resulting in a septate uterus with longitudinal vaginal septum Pregnancy There appears to be a higher risk of recurrent miscarriage associated with longer septa, but this is controversial and many untreated women have good pregnancy outcomes. Pregnancy outcomes reported in such women revealed spontaneous abortion in 21-44 percent, preterm delivery in 12-33 percent, and live birth in 50-72 percent. Treatment Hysteroscopic metroplasty has become the method of choice for repair of most uterine septa. Benefits to the transcervical approach include less morbidity, no abdominal or transmyometrial incisions, and faster return to normal activity. Various techniques and instruments are used either to incise or remove the septum. Two of the most common instruments are the semirigid or rigid scissors (7 French) or the 8 mm wire loop urologic resectoscope operated through the 21 French sheath. Potassium-titan-phosphate (KTP/532), neodynamic:yttrium aluminum garnet (Nd:YAG), and argon lasers also have been used. If however the septum cannot be safely removed hysteroscopically, then an abdominal or laparoscopic approach, such as the Jones or Tompkins metroplasty, can be used. 42 Foot Two views of