Congenital malformations of uterus and vagina

Congenital malformations of uterus and vagina result from failure of development, failure of fusion or septal reabsorption of the Mullerian ducts. They present with a spectrum of findings ranging from agenesis to duplications. They are of clinical importance because of their association with menstrual disorders and impaired fertility. Furthermore, women with Mullerian duct anomalies (MDAs) have a significant risk of obstetric complications such as spontaneous abortion, stillbirth and preterm delivery. Hysterosalpingography (HSG) and laparoscopy have long played a pivotal role in the evaluation of MDAs. Ultrasonography and recently magnetic resonance imaging (MRI) have emerged as noninvasive modalities that are used complementarily or as alternative diagnostic tools. The radiographic findings according to the classification of Buttram and Gibbons are described for HSG, ultrasound and MRI. The advantages and limitations of each method are discussed, and finally an algorithm for imaging is recommended.