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Uterine horn

The uterine horn is the superolateral region of the uterus where the uterine cavity communicates with the lumen of the fallopian tubes. It serves as an important anatomical landmark in gynecology and imaging, as it represents the point of transition between the uterus and adnexal structures. The uterine horn has surgical significance in hysterectomy, tubal ligation, and evaluation of congenital uterine anomalies.

Synonyms

  • Cornua of the uterus

  • Uterine cornu

  • Uterotubal junction

Location and Relations

  • Located at the superolateral angles of the uterine cavity

  • Anteriorly: Related to the round ligament of the uterus, which attaches at the horn and passes into the inguinal canal

  • Posteriorly: Related to the uterosacral ligaments and peritoneal reflection

  • Laterally: Continuous with the fallopian tubes at the uterotubal junction

  • Inferiorly: Connected to the upper body of the uterus

Function

  • Acts as the entry point for fallopian tubes, allowing passage of the oocyte from the tube into the uterine cavity

  • Serves as a supportive site for the round ligament, maintaining uterine position

  • Plays a role in fertility and reproductive physiology by facilitating communication between the uterus and adnexa

Clinical Significance

  • Important landmark in surgical procedures such as hysterectomy and sterilization

  • Site for ectopic pregnancies (interstitial/cornual pregnancies), which are potentially life-threatening

  • Evaluated in congenital uterine anomalies such as bicornuate, unicornuate, or septate uterus

  • May be involved in fibroids, adenomyosis, or neoplastic invasion extending toward the adnexa

  • Frequently assessed in imaging for infertility evaluation and tubal patency studies

MRI Appearance

T1-weighted images:

  • Uterine horn appears as low-to-intermediate signal intensity consistent with myometrium

  • Endometrial cavity at the horn appears with slightly higher signal intensity compared to myometrium

T2-weighted images:

  • Myometrium of the uterine horn shows intermediate signal intensity

  • Endometrial cavity at the horn appears as bright signal intensity

  • Congenital anomalies (e.g., bicornuate uterus) show duplication or separation of uterine horns

STIR (Short Tau Inversion Recovery):

  • Normal uterine horn myometrium shows intermediate-to-low signal

  • Pathologies such as adenomyosis or ectopic pregnancy appear as bright signal intensity

T1 Fat-Sat Post-Contrast:

  • Myometrium enhances homogeneously and moderately

  • Endometrium shows distinct higher enhancement

  • Pathology (ectopic pregnancy, fibroid, tumor) shows variable enhancement patterns

CT Appearance

Non-Contrast CT:

  • Uterine horn appears as a soft tissue structure contiguous with the uterine body

  • Endometrial cavity may be faintly visualized as lower attenuation

  • Calcified fibroids or adnexal pathology may be detected in the region of the horn

Post-Contrast CT:

  • Uterine horn enhances along with the rest of the uterus

  • Myometrium enhances homogeneously

  • Endometrium enhances distinctly, especially in the early phases

  • Pathologies (ectopic pregnancy, tumors, fibroids) show focal or heterogeneous enhancement

MRI image

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MRI image

uterine horn MRI sagittal anatomy image-img-00000-00000

CT image

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