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