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case_images: Transrectal ultrasonography.. Ultrasonography shows a 1.5-cm-thick endometrial layer in the right uterus (short arrow) and up to 2.69 cm in the left uterus (long arrow). The mass was connected to the left uterus and appeared to be extending into the vaginal cavity. Internal blood flow was increased.
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case_images: Its irregular-shaped margins and increased blood flow suggested the possibility of malignancy ( Figure 1).
case_images: Magnetic resonance imaging (coronal view, T2 W1).. This scan shows an approximately 15- x 9- x 17-cm mass with mixed high and low signal intensity and irregular margins in the lower abdomen on coronal view.
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case_images: Pelvic MRI was performed on the day after the patient's initial presentation, revealed underlying uterus didelphys with an approximately 15- x 9- x 17-cm mass with mixed signal intensity in the lower abdominal area ( Figure 2) and an approximately 6- x 2.7- x 3-cm mass of the left cervix and lower uterine body on
case_images: Positron emission tomography/computed tomography.. An approximately 13-cm intensely hypermetabolic hemorrhagic mass is noted in the pelvic cavity, suggestive of a subserosal uterine mass possibly connected with a cervical lesion. There are regions of hypermetabolic peritoneal thickening and nodules with a small amount ascites.
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case_images: The arrow is pointing the ruptured portion of left uterine horn of the bicornuate uterus.. Rupture length was about 3cm. Mesentery of small bowel was partially adhered to the uterine mass. A significant amount of hemoperitoneum was observed. Estimated blood collection in cul-de-sac was 1000 to 1500 mL. (A) Left uterus (B) Small bowel (C) Mass.
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case_images: Surgical exploration revealed a ruptured bicornuate uterus with a large mass within the left uterine horn ( Figure 4).