Title : Ultrasound diagnosis of ACUM: A case study based on personal observations
Abstract:
We present to your attention four cases of Ultrasound Diagnosis of a rare uterine anomaly: ACUM. All presented patients had active complaints of lower abdominal pain associated with the menstrual cycle. The examinations were performed using Voluson E8 Expert, Voluson E10 Expert, MINDRAY M7 and MINDRAY Imagyn 9 ultrasound systems with volumetric sonography. The first patient is a 16-year-old female presented with lower abdominal pain occurring during the second phase of the menstrual cycle. The ultrasound performed using Voluson E8 There was a normally sized, pear-shaped uterus. A well-defined, round cystic lesion with a diameter of 15 mm was visualized within the uterine wall, surrounded by myometrium and not connected to the uterine cavity. A 3D ultrasound was performed, showing an accessory cavity along the border of uterus. MRI confirmed the presence of a cystic lesion within the uterine body, suggestive of ACUM. The second case is a 29-year-old female with a history of two pregnancies, one spontaneous delivery, and one miscarriage. A retroverted , saddle-shaped uterus was identified. An accessory 38 x 35 mm cystic cavitary lesion was interstitially visualized along the left uterine border, containing echogenic material with internal debris. The cavitary lesion was surrounded by a concentric myometrial layer up to 4 mm thick and was not connected to the uterine cavity.
MRI confirmed the diagnosis: The third case is presented by a 21-year-old female with left-sided lower abdominal pain. Initial B-mode ultrasound was performed using the MINDRAY M7 system. Differential diagnostics were performed between an accessory non-communicating uterine horn and an endometrioma. A round cystic lesion measuring 18 mm was identified along the left uterine border. The patient was examined dynamically after 2, 3, 5, 6 months, with no significant change in ultrasound findings.
MRI confirmed ACUM: The fourth case includes a 17-year-old female presented with dysmenorrhea. Transabdominal and transrectal ultrasound were performed using the MINDRAY Imagyn 9 system. A cavitary lesion measuring 20 mm with smooth inner contours and "ground-glass" content was visualized in continuity with the left lateral uterine wall, surrounded by myometrium. 3D reconstruction in the coronal plane showed a normal uterine cavity. Conclusion: Accessory cavitated uterine malformation (ACUM).
MRI confirmed the diagnosis: The patient is scheduled for surgical management. The presented cases highlight the importance of utilizing advanced imaging methods to establish an accurate diagnosis. While standard B-mode ultrasound can suggest this rare uterine anomaly, 3D sonography provides reliable visualization of it, MRI should be used as a clarifying imaging method.
