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Key Terms

  1. Bicornuate uterus: a uterine abnormality resulting from complete failure of the two embryologic uterine horns to fuse, thereby most commonly resulting in one cervix but two separate uterine horns.

  2. Fusion anomaly: a uterine malformation resulting from complete or partial failure of embryologic urogenital tissue to fuse during development.

  3. Hydro- / hemato- / pyo- colpos, -metra, -metrocolpos: water (hydro), blood (hemato), or pus (pyo) within uterine lumen (-metra), upper vagina (colpos), or both (-metrocolpos).

  4. Septate uterus: a uterine malformation resulting from failure of the two embryologic uterine horns to fuse completely, generally resulting in a smooth fundal contour associated with mostly fibrous septum extending to variable lengths form the fundus toward the cervix.

  5. T-shaped uterus: a malformed uterus that has a T-shaped endometrial lumen, resulting largely from a tubular-shaped lower uterine segment and a wider than normal fundal element, often associated with embryologic DES exposure.

  6. Uterus didelphys: a uterine abnormality resulting from almost complete failure of embryologic urogenital tissue to fuse, thereby resulting in two separate uterine horns, each associated with its own cervix, and frequently associated with a longitudinal vaginal septum.

  7. Uterine artery (fibroid) embolization (UAE): an interventional radiographic technique in which catheters are used to embolize flow to one or more uterine fibroids.


The ability of sonography, in particular transvaginal sonography (TVS), to depict subtle changes in the myometrium and endometrium makes it the diagnostic modality of choice for the evaluation of many uterine disorders. With sonography, the uterus can be imaged in several scan planes. Because the images are obtained in real time, and uterine orientation can be variable, the sonographer can empirically alter the scanning plane and gain settings for optimal depiction of the endometrium and myometrium. Because of its proximity to the uterus, a transvaginal transducer/probe can enhance the sonographic depiction of the uterus and endometrium.

Once a uterine lesion is suspected clinically, TVS can be used to establish the presence, size, extent, and internal consistency of the lesion and to detect associated pathology, such as liver metastases. Sonography has a major role in differentiating palpable uterine masses from those that arise from adnexal structures. The specific diagnosis can be confirmed by endometrial biopsy or through dilation and curettage (D&C). Alternatively, other imaging techniques, such as hysterosalpingography and, in some cases, even direct hysteroscopic visualization may be useful. Magnetic resonance imaging (MRI) and computed tomography (CT) can also demonstrate uterine and parauterine anatomy, and are particularly useful in staging known uterine neoplasms.

TVS has an important role in establishing the presence of diffuse and/or localized adenomyosis, a common cause of abnormal uterine bleeding characterized by endometrial glandular extension into the myometrium. On TVS, adenomyosis appears as an irregular myometrial texture including a “venetian blind” pattern secondary to fibrosis that occurs surrounding a myometrial implant.1 Another TVS finding in adenomyosis is apparent disruption in the outer endometrial—inner myometrial interface ...

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