3D Coronal Ultrasound in Diagnosis of Accessory and Cavitate
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Accessory and cavitated uterine mass is a rare developmental Mullerian anomaly. There is a non-communicating uterus-like mass that occurs contiguously along the wall of the uterus often underdiagnosed and needs the expertise to identify. The study states that 3D coronal ultrasound can be very helpful in diagnosis.

A 28-year-old married female presented with dysmenorrhea and chronic pelvic pain. On ultrasound, a homogeneously isoechoic mass was noted in the right lateral wall of the uterus with central echogenicity. On 3D reconstruction, the main uterine cavity was normal and both cornua were visualized without any recognized Mullerian anomaly. No communication with the main endometrial cavity seen. On laparoscopy, mass was located under right round ligament insertion. Sectioning revealed chocolate-colored fluid.

ACUM is a non-communicating uterus-like mass. It resembles the uterus both macroscopically and microscopically. It represents a cavitated mass lined by endometrial glands and stroma surrounded by irregular smooth muscle cells.

Criteria for diagnosing ACUM are (1) accessory cavitated mass located under round ligament; (2) normal uterus, fallopian tubes, and ovaries (3) surgical case with excised mass and pathological examination; (4) accessory cavity lined by endometrium with glands and stroma; (5) chocolate-brown fluid contents. On ultrasound, they appear solid isoechoic masses with central cystic areas separate from ovaries.

In particular, 3D reconstruction can be used to rule out Mullerian anomaly. 3D ultrasound can be highly accurate in making the diagnosis.

The Journal of Obstetrics and Gynecology of India
Source: https://doi.org/10.1007/s13224-021-01474-1