Uterus Didelphys: Diagnostic Approach and Clinical Significance

Diagnostic Approach

The American College of Radiology recommends MRI as the gold standard for diagnosing and classifying uterus didelphys with 100% accuracy in surgically proven Müllerian duct anomalies 3
3D transvaginal ultrasound (TVUS) serves as an excellent alternative with 92% accuracy in classification of Müllerian duct anomalies 3
Hysterosalpingography (HSG) has poor accuracy (only 16.7%) and cannot reliably differentiate between septate and bicornuate uterus, making it inadequate for diagnosing uterus didelphys 3
Uterus didelphys shows two completely separate uterine horns with two cervices on imaging, distinguishing it from other anomalies like septate or bicornuate uterus 1, 4

Two distinct endometrial cavities that do not communicate are characteristic of uterus didelphys 1, 4
Fundal cleft depth helps differentiate from bicornuate uterus: a cleft >1 cm suggests bicornuate rather than septate uterus, though didelphys shows complete separation 3

Patients with uterus didelphys may experience dysmenorrhea, dyspareunia, or vaginal bleeding when symptomatic 2