Figure 7.

Uterine anomalies. Three-dimensional sonography has become the 'gold standard' investigation for the diagnosis and exclusion of congenital uterine anomalies. Its extremely high sensitivity and specificity relate to its ability to demonstrate the plane coronal perpendicular to the transducer face and in doing so allow visualisation of the fundal contour and comparison of the myometrium with the endometrium throughout the uterine length. Figure 7a shows normal cornna with straight contours at the upper aspect of the cavity in contrast to the characteristic concave contour seen in arcuate uteri (Fig. 7b) and the deeper contour of various length seen in sub-septate uteri (Figs. 7c, 7d & 7e). Any indentation of the fundal contour may also be appreciated in the coronal plane as seen in the multiplanar display in Figure 7f. This uterus had been considered normal with conventional ultrasound, which only provides the longitudinal and transverse views seen in the upper two images, but laparoscopy had demonstrated a bulky uterus with a possible fundal defect and a follow-up three-dimensional ultrasound confirmed the presence of a significant septum. The size of the septal defect can be measured as shown in Figure 7g but may be less important than the remaining length of the cavity shown as a bold dashed line.