AJR:191, August 2008 W71 Letters AJR 2008; 191:W71 0361–803X/08/1912–W71 © American Roentgen Ray Society Uterine Diverticula and Accessory Ducts Our patient is a 34-year-old woman inves- tigated for secondary infertility. She has two children born by uncomplicated vaginal de- livery. The patient has no history of surgery, trauma, or pelvic infection. Hysterosalpingo- graphy revealed an anteflexed uterus. Both fallopian tubes were normal. An additional tubular structure arising from the left side of the uterus at the junction of the body and cervix was noted (Figs. 1A and 1B). Two small diverticula were seen on the right. In our opinion, these findings are a devel- opmental anomaly, not an acquired condi- tion. We consider this to be a true duplication (splitting) of either mesonephric or parame- sonephric duct. We use the term mesonephric for Wolffian and paramesonephric for mül- lerian ducts, as preferred by embryologists. The splitting occurs at the 7th week [1]. The division may be short, or it may be extensive and bilateral [1]. The duplicated parameso- nephric duct runs parallel to the normal tube and may fuse with it on one or both ends. In the radiologic literature [2], the duplication of the paramesonephric duct means either failure of fusion (types II, III, IV) or failure of septal resorption (types V or VI). True du- plications of the mesonephric and parameso- nephric ducts are not mentioned. Clinical manifestations include incidental findings, as in our case; parauterine pelvic mass; uterine diverticula; accessory or rudi- mentary horn of the uterus; accessory tube; renal and ureteric abnormalities; or a com- bination of these. Mesonephric and parame- sonephric duct duplications may coexist in the same patient. Histology will differentiate between the two. Cervical diverticula are occasionally seen, but true uterine diverticula are extremely rare in nonpregnant women [3]. They represent localized duplication of the distal parameso- nephric duct and may mimic uterine saccula- tion of pregnancy. Most of the accessory di- verticula and tubes are a portion of the epoo- phoron, which is a mesonephric duct remnant [1]. The most common complications are dys- menorrhea, infection, and ectopic pregnancy. Ectopic pregnancy may mimic abdominal pregnancy, has a 70% chance of rupture, and does not respond to induction of labor. Sa- haran and Parulekar [4] described a patient with a rudimentary horn of the uterus and an anomalous tubular structure on the right, where a normal ureter is expected. The right kidney and ureter were absent. The diagnosis of persistent mesonephric duct was confirmed at surgery and by biopsy. Our presentation has two drawbacks. First, the status of the right kidney and ureter are unknown because evaluation of the urinary tract was not done. Second, there was neither surgical nor biopsy correlation because these were not indicated. True duplications are documented in the anatomic, pathologic, surgical, and gynecologic literature, but we did not find any references in the available English-language radiologic literature. The diverticula and accessory duct are compatible with both mesonephric and paramesonephric duct. On the basis of the course of the additional tube, we believe that our case is a true duplication of the mesonephric duct. Peter Evan Netcare Park Lane Clinic Johannesburg, Republic of South Africa Beverley Kramer University of Witwatersrand Johannesburg, Republic of South Africa DOI:10.2214/AJR.07.3679 WEB—This is a Web exclusive article. References 1. Gray SW, Skandalakis JE. Embryology for sur- geons. Philadelphia, PA: W. B. Saunders, 1972: 596–597, 640, 651 2. Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology 2004; 233:19–34 3. Engel G, Rushovich AM. True uterine diverticu- lum. A partial mullerian duplication? Arch Pathol Lab Med 1984; 108:734–736 4. Saharan SP, Parulekar SV. Hemihaematometra with persistent underdevelped Wolffian duct. J Posgrad Med (serial online) 1993 (cited 2007 Dec 19); 39:98. http://www.jpgmonline.com/text/asp? 1993/39/2/98/623 A Fig. 1—34-year-old woman examined for secondary infertility. A and B, Hysterosalpingogram shows extra tube on left (white arrow). Two uterine diverticula are seen on right (black arrows). B Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved