March 31, 2012

Cesarean Section Scar Diverticulum


A sagittal US scan of the uterus shows a cystic lesion in the anterior wall of the lower uterine segment. The patient reported prior cesarean section

Facts:
  • Defect within the lower uterine cavity in patients with history of cesarean section in expected location of a hysterectomy incision
  • Based on a study utilizing hysterosalpingograms, 60% of women with prior C-section had this anatomic defect
  • Knowledge of this anatomic defect avoids misdiagnosing it as other pathology
  • Often benign clinical significance. Some reports of ectopic scar pregnancy and abnormal uterine bleeding associated with this pathology
Imaging Appearance
  • Focal outpouching (most common feature) and thin linear defect
  • Location: lower uterine segment (most common) > uterine isthmus, upper endocervical canal

Imaging Mimics
  • Prominent cervical glands (tubular, symmetric structure from both walls of endocervical canal)
  • Postmyomectomy diverticula (unilateral, from site of resection, correlated with surgical history and location of diverticula)
  • Gartner's duct cyst (long, tubular structure parallel to uterine cavity)
  • Adenomyosis (location of defect anywhere along uterine cavity)

Reference
Surapaneni K, Silberzweig JE. Cesarean section scar diverticulum: appearance on hysterosalpingography. AJR 2008;190:870-4

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