PMC5119691_01
PATIENT 1: (A) CECT sagittal reformation reveals a reniform cystic lesion (open arrow) in the pelvis with adjacent fat stranding (arrow); (B) Coronal reconstruction shows divergent uterine cornua (red arrows) with focal collection on the left side (yellow arrow). Also noted is the absence of the left kidney (UB - urinary bladder).
poljradiol-81-549-g001.jpg
PMC5119691_01_poljradiol-81-549-g001.jpg
f1-poljradiol-81-549
The patient underwent CT at a private centre which showed a cystic lesion, reniform in configuration, in the left pelvis (Figure 1A). There was adjacent inflammation (Figure 1A) and the left kidney was not seen in left renal fossa. Also, the two uterine horns were unfused (Figure 1B) with a focal collection on the left side (Figure 1B).
PATIENT 1: Endovaginal scan depicts dilated, tortuous left fallopian tube (solid arrows) with echogenic fluid (T) within (Small block arrow - pelvic free fluid; open arrows - two separate endometrial echoes).
poljradiol-81-549-g002.jpg
PMC5119691_01_poljradiol-81-549-g002.jpg
f2-poljradiol-81-549
However, the cystic reniform structure appeared to be dilated and tortuous left fallopian tube, full of fluid with internal echoes (Figure 2).
PATIENT 1: (A) Pelvic MRI in oblique coronal plane demonstrates uterus didelphys with blind left hemivagina (yellow arrow). The blue arrow represents normal right ovary. The left ovary is not seen separately; instead a cystic lesion with fluid-fluid level is seen (open arrows in B and C). The white arrow in C points towards fat stranding (UB - urinary bladder; red arrows - two separate endometrial cavities)).
poljradiol-81-549-g003.jpg
PMC5119691_01_poljradiol-81-549-g003.jpg
f3-poljradiol-81-549
There was presence of retained collection in the left hemivagina limited by a septum (Figure 3A). The left ovary was not visualised separately from this cystic lesion (Figure 3B, 3C).
PMC5119691_02
PATIENT 2: Serial axial T2 images reveal two unfused uterine cornua (red arrows) with dilated right horn (Blue arrows - normal ovaries; H - hematocolpos; UB - urinary bladder).
poljradiol-81-549-g004.jpg
PMC5119691_02_poljradiol-81-549-g004.jpg
f4-poljradiol-81-549
MRI examination revealed a dilated uterine horn on right (Figure 4) with an absent ipsilateral kidney (Figure 5).
PATIENT 2: Coronal T1WI of the abdomen and pelvis shows hematocolpos (H) of the right horn with an absent ipsilateral kidney. The white arrow points towards contralateral normal kidney.
poljradiol-81-549-g005.jpg
PMC5119691_02_poljradiol-81-549-g005.jpg
f5-poljradiol-81-549
MRI examination revealed a dilated uterine horn on right (Figure 4) with an absent ipsilateral kidney (Figure 5).
PMC5119691_03
PATIENT 3: Sagittal T2 SPAIR images reveal normal left uterine cavity (A) and hematometrocolpos on the right (B). On coronal images (C, D), two uterine horns (red arrows) are seen separately with a dilated right horn (UB - urinary bladder).
poljradiol-81-549-g006.jpg
PMC5119691_03_poljradiol-81-549-g006.jpg
f6-poljradiol-81-549
An MRI was performed which showed a didelphic uterus with hematometrocolpos in the right endometrial cavity (Figures 6-8), thus, establishing a diagnosis of OHVIRA syndrome.
PATIENT 3: Serial axial T2WI depict two widely-separated uterine cavities (red arrows) with a dilated right one.
poljradiol-81-549-g007.jpg
PMC5119691_03_poljradiol-81-549-g007.jpg
f7-poljradiol-81-549
An MRI was performed which showed a didelphic uterus with hematometrocolpos in the right endometrial cavity (Figures 6-8), thus, establishing a diagnosis of OHVIRA syndrome.
PATIENT 3: Coronal T1WI shows an absent right kidney. The green arrow depicts a bowel loop occupying the empty right renal fossa (L - liver; S - spine).
poljradiol-81-549-g008.jpg
PMC5119691_03_poljradiol-81-549-g008.jpg
f8-poljradiol-81-549
An MRI was performed which showed a didelphic uterus with hematometrocolpos in the right endometrial cavity (Figures 6-8), thus, establishing a diagnosis of OHVIRA syndrome.
PMC5119691_04
PATIENT 4: Ultrasonogram shows hematometra, hematosalpinx (red arrows) in the right uterine cornua and a normal right ovary (blue arrow).
poljradiol-81-549-g009.jpg
PMC5119691_04_poljradiol-81-549-g009.jpg
f9-poljradiol-81-549
Ultrasound showed two widely separated uterine horns, a non-obstructed normal-appearing left uterus and cervix and hematometra/hematosalpinx on the right side (Figure 9).
PATIENT 4: Axial T2W (A) and T1W (B) images show widely divergent uterine horns, non-obstructed normal left uterine horn (red arrow), hematometra and hematosalpinx (black arrows) in the obstructed right uterus (H - hematometra; UB - urinary bladder). T2WI in sagittal plane (C, D) reveal similar findings.
poljradiol-81-549-g010.jpg
PMC5119691_04_poljradiol-81-549-g010.jpg
f10-poljradiol-81-549
These findings were confirmed on MRI (Figure 10). Additional imaging of urinary system showed right renal agenesis (Figures 10, 11).
PATIENT 4: Coronal T2WI of the abdomen shows renal agenesis on the right side (L - liver).
poljradiol-81-549-g011.jpg
PMC5119691_04_poljradiol-81-549-g011.jpg
f11-poljradiol-81-549
Additional imaging of urinary system showed right renal agenesis (Figures 10, 11).