Phillip A Romanski1, Pietro Bortoletto2, Samantha M Pfeifer2. 1. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6th Floor New York, New York 10021. Electronic address: par9114@med.cornell.edu. 2. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6th Floor New York, New York 10021.
Abstract
BACKGROUND: Obstructed Müllerian anomalies in adolescents can be grouped into complete outflow obstruction or unilateral outflow obstruction. The challenge with unilateral obstructions is that diagnosis can be delayed for weeks to years as menstruation occurs normally through the patent side and thus obstruction is often not initially considered in the differential diagnosis. CASE: In this case series, we present three unusual and challenging cases of unilateral Müllerian obstructions in adolescent females along with strategies for diagnosis and management. Each case involves a unique variation to a recognized Müllerian anomaly that was initially misdiagnosed leading to a significant delay in definitive diagnosis and treatment. SUMMARY AND CONCLUSION: These cases highlight that even amongst the well described Müllerian anomalies there can be unusual variations. Patients that do not respond to initial management or develop new symptoms should be further evaluated to confirm the correct diagnosis Tools that may be helpful in making the correct diagnosis include imaging studies that use contrast dye to better delineate cavities and their connections, magnetic resonance imaging with a radiologist experienced in Müllerian anomalies, and an exam under anesthesia. A definitive diagnosis is critical to the successful management of these conditions and individualized management plans are required for each patient depending on their specific anomaly and their preferences for treatment.
BACKGROUND: Obstructed Müllerian anomalies in adolescents can be grouped into complete outflow obstruction or unilateral outflow obstruction. The challenge with unilateral obstructions is that diagnosis can be delayed for weeks to years as menstruation occurs normally through the patent side and thus obstruction is often not initially considered in the differential diagnosis. CASE: In this case series, we present three unusual and challenging cases of unilateral Müllerian obstructions in adolescent females along with strategies for diagnosis and management. Each case involves a unique variation to a recognized Müllerian anomaly that was initially misdiagnosed leading to a significant delay in definitive diagnosis and treatment. SUMMARY AND CONCLUSION: These cases highlight that even amongst the well described Müllerian anomalies there can be unusual variations. Patients that do not respond to initial management or develop new symptoms should be further evaluated to confirm the correct diagnosis Tools that may be helpful in making the correct diagnosis include imaging studies that use contrast dye to better delineate cavities and their connections, magnetic resonance imaging with a radiologist experienced in Müllerian anomalies, and an exam under anesthesia. A definitive diagnosis is critical to the successful management of these conditions and individualized management plans are required for each patient depending on their specific anomaly and their preferences for treatment.