2D Ultrasound (2D US) and Sonohysterography (SHG) for the Diagnosis of Female Genital Anomalies

Abstract

Aim: The aim of this chapter is to present the diagnostic tricks and tips of 2D ultrasound (2D US) and sonohysterography (SHG) in the estimation of female genital anatomy giving as examples figures of different types of uterine pathology and to critically evaluate the diagnostic performance of these techniques elucidating their role for screening and diagnosis. Brief description of the reviewed data: The 2D US and SHG can easily and reliably identify some female genital anomalies such as uterine agenesis, unicornuate uterus with a rudimentary horn and didelphic uterus. An isolated unicornuate uterus without a rudimentary horn may not be recognized with 2D US. It can be suspected by an extremely laterodeviation of the uterus, an endometrial stripe in transverse section with circle shape and the visualization of only one intramural tubal part. In case of didelphic uterus, two splayed endometrial layers at the 2D US transverse section are visualized and a complete separation of the uterine horns and cervical canals during SHG can be seen. 2D US recognize a bicornuate uterus with a large fundal cleft and a large divergence of the two uterine horns and the endometrial stripe. A septate uterus is suspected when in 2D transverse section of the uterus a double endometrial stripe without doubling of the myometrium tissue is seen. This transverse fundal view is similar in case of arcuate uterus. Clinical implications: 2D US is the initial diagnostic test for congenital anomalies. Some congenital anomalies are difficult to distinguish. The coronal or frontal view of the uterus cannot be obtained by 2D US like 3D US, therefore it is difficult to distinguish accurately arcuate from septate from partial bicornuate uterus. SHG shares limitations similar to those of conventional 2D TVS on the evaluation of external uterine profile and the global view of uterine pelvis. Open issues for further research: T-shaped uterine configuration needs to be better defined by ultrasound. Further color and pulsed Doppler studies of the uterine vascularization in case of congenital anomalies could be correlated to different fertility problems and obstetric outcomes.