Differential Diagnosis
- Single most likely diagnosis
- Uterine anomaly (specifically, a septate uterus): The patient's pelvic ultrasound reveals a divergent endometrial cavity with an indented fundus, which is consistent with a septate uterus. This condition can cause an irregular uterine contour on pelvic examination, as noted in the patient's case.
- Other Likely diagnoses
- Uterine fibroids: The patient's irregular uterine contour on pelvic examination could also be due to uterine fibroids, which are common in women of reproductive age. However, the ultrasound findings are more suggestive of a uterine anomaly.
- Adenomyosis: The patient's symptoms of bloating, breast soreness, and mild cramping prior to menses could be consistent with adenomyosis, but the ultrasound findings do not specifically support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine cancer: Although unlikely in a 26-year-old woman, uterine cancer must be considered in the differential diagnosis, especially given the irregular uterine contour. However, the patient's age and lack of other symptoms make this diagnosis less likely.
- Endometrial hyperplasia: This condition can cause irregular uterine bleeding and an irregular uterine contour, but it is less likely in this patient given her regular menstrual cycles and normal ultrasound findings.
- Rare diagnoses
- Uterine malformation (e.g., unicornuate or bicornuate uterus): These conditions are rare and can cause an irregular uterine contour, but the patient's ultrasound findings are more consistent with a septate uterus.
- Asherman's syndrome: This condition involves intrauterine adhesions and can cause an irregular uterine contour, but it is less likely in this patient given her lack of history of uterine surgery or instrumentation.