This is the case of a 46-year-old woman who first presented to gynaecology clinic aged 26 with severe dysmenorrhoea. She has medical history of left renal agenesis and a previous left oophorectomy. Over the course of 20 years she was extensively imaged with ultrasound (US), magnetic resonance imaging (MRI) and computerised tomography (CT) with the diagnosis of a right unicornuate uterus with an obstructed left rudimentary horn only made recently following 11 scans. There are many factors in this case that confused the picture and made diagnosis more challenging including an incomplete history, language barrier, possibility of a pelvic kidney and changes in imaging of an obstructed horn.