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An arcuate uterus is a common normal variant of Müllerian duct development, characterized by a shallow indentation of the uterine fundus due to incomplete resorption of the midline septum. Unlike septate or bicornuate uterus, it does not impact fertility and generally does not require intervention.

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Embryology

• Represents a mild failure of resorption of the median uterine septum after normal fusion of the Müllerian ducts.
• Fundal indentation is broad and shallow, not associated with reproductive complications in most cases.

Classification

![Classification of MDAs on the basis of the American Society for Reproductive Medicine system.

Image courtesy of Joanna Culley, BA Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian Duct Anomalies. RadioGraphics. 2012;32(6):E233-E250. doi:https://doi.org/10.1148/rg.326125515](https://s3-us-west-2.amazonaws.com/secure.notion-static.com/52442e06-da2c-4a76-a12a-1613cb93ba39/Untitled.png)

Classification of MDAs on the basis of the American Society for Reproductive Medicine system.

Image courtesy of Joanna Culley, BA Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian Duct Anomalies. RadioGraphics. 2012;32(6):E233-E250. doi:https://doi.org/10.1148/rg.326125515

Clinical Features

• Typically asymptomatic
• Incidental finding on imaging or during infertility workup
• May rarely be associated with:
  • Miscarriage (controversial)
  • Poor obstetric outcomes in select studies
• Generally considered a normal variant

Radiology

Differentiating features:** • Septate uterus (sharp, deep indentation) • Bicornuate uterus (fundal cleft >10 mm, myometrial separation) | | HSG | Cannot distinguish arcuate vs septate reliably without correlating external contour • Shows single endometrial cavity with a broad concave fundal impression |

![Differences between arcuate, septate, and bicornuate uteri with imaging features of the arcuate uterus. 11.1: Diagrammatic representation of differences between arcuate, septate, and bicornuate uteri. 11.2. Arcuate uterus: axial T2W MR image (a) of an arcuate uterus in a 26-year-old female patient with recurrent pregnancy loss shows a normal external fundal outline (white arrowheads) with an internal indentation lesser than 1.5 cm (double-headed arrow) from the interostial line. Note normal ovaries bilaterally (arrows). b 3D transvaginal USG image shows a broad saddle-shaped indentation of the arcuate uterus

Dixit, R., Duggireddy, C.S. & Pradhan, G.S. Mullerian anomalies: revisiting imaging and classification. Insights Imaging 16, 40 (2025). https://doi.org/10.1186/s13244-024-01879-2](attachment:e0f46e8a-1031-4c94-a40a-8159a25f3abf:13244_2024_1879_Fig11_HTML.webp)

Differences between arcuate, septate, and bicornuate uteri with imaging features of the arcuate uterus. 11.1: Diagrammatic representation of differences between arcuate, septate, and bicornuate uteri. 11.2. Arcuate uterus: axial T2W MR image (a) of an arcuate uterus in a 26-year-old female patient with recurrent pregnancy loss shows a normal external fundal outline (white arrowheads) with an internal indentation lesser than 1.5 cm (double-headed arrow) from the interostial line. Note normal ovaries bilaterally (arrows). b 3D transvaginal USG image shows a broad saddle-shaped indentation of the arcuate uterus

Dixit, R., Duggireddy, C.S. & Pradhan, G.S. Mullerian anomalies: revisiting imaging and classification. Insights Imaging 16, 40 (2025). https://doi.org/10.1186/s13244-024-01879-2

Differentials