MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

Abstract

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.