Ultrasonographic Imaging Features of Accessory Cavitated Uterine Malformations and Application to Diagnosis.

Objective: To analyze the ultrasonographic imaging features of accessory cavitated uterine malformations (ACUM) and discuss the practical value of ultrasonography in diagnosing this disease.

Methods: A retrospective analysis was conducted on nine cases of ACUM diagnosed by ultrasound and confirmed by surgery and pathology at Peking University Shenzhen Hospital from October 2020 to August 2024. The ultrasonic imaging features of ACUM were summarized.

Results: The average age of the nine patients with ACUM was 28.3 years (range: 18-39 years). Only one patient exhibited mild dysmenorrhea, while the remaining eight patients experienced severe and progressive dysmenorrhea. Among those with severe dysmenorrhea, the average age was 19.9 years (range: 13-38 years), and the mean time of onset after menarche was 6.5 years (range: 0-25 years). The results of preoperative ultrasonography were consistent with the surgical results, and the diagnostic coincidence rate was 100%. Preoperative ultrasound showed eight cases (88.9%) appeared as solitary lesions, and one case (11.1%) exhibited two cystic cavities on the same side of the uterus. Lesions were located on the anterior lateral wall of the uterus, below the uterine horn, with a median maximum diameter of (24.4 ± 3.6) mm. Lesions were round or oval and not connected to the uterine cavity, with clear boundaries, presenting as regular thick-walled cystic structures. Cystic areas were observed within the mass with a ground-glass-like appearance (88.9%) or hyperechoic (11.1%). The surrounding area of the mass showed resemblance to the muscular layer, and circular or semicircular vascularity was detected around the mass. No adenomyosis or other uterine lesions were found.

Conclusions: ACUM is a rare obstructive reproductive tract malformation that affects young women. Progressive aggravation of dysmenorrhea serves as its main clinical manifestation. ACUM exhibits distinct ultrasound characteristics; preoperative ultrasonography can be used to accurately diagnose ACUM through identification of typical manifestations, providing a reliable imaging basis for diagnosis and treatment management.