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TITLE: ACCESSORY CAVITATED UTERINE MASS (ACUM) : ?A RARE BUT SIGNIFICANT CAUSE OF DYSMENORRHEA? ABSTRACT INTRODUCTION: Accessory cavitated uterine mass(ACUM) is a rare form of developmental Mullerian anomaly characterised by non communicating accessory uterine cavity in otherwise normal uterus with symptoms of severe dysmenorrhea, pelvic pain and infertility in young women age group. AIMS & OBJECTIVE: To discuss the clinical features, ultrasound and MRI findings of ACUM To discuss the management options in case of ACUM MATERIAL AND METHOD: A case of 19 yrs old unmarried female with severe dysmenorrhea since menarche which does not get relieved despite using NSAID?S & oral contraceptives. Ultrasonography was done which showed homogenous cystic mass of 20x20mm, Magnetic Resonance Imaging was done which was suggestive of cavitated mass with hemorrhagic content in it ,located on left side of myometrial wall in normal size uterus just below the round ligament and interstitial part of fallopian tube. After proper evaluation and counselling of patient decision was taken for surgical intervention (Laparoscopic excision) RESULTS: A case of 19yrs old female was taken that met the criteria for ACUM.ON USG ACUM appeared as unilocular cyst , hemorrhagic content was observed on MRI with high signal intensity on both T2 &T1 weighted images .Patient was managed surgically( laparoscopic excision of the cavity).No adverse outcome was reported. Patient was followed in OPD with relieved symptoms of dysmenorrhea. CONCLUSION: ACUM is a newly recognised clinical entity which often remains undiagnosed because of its clinical similarities with other myometrial masses .It differs from other Mullerian abnormalities by having normal endometrial cavity. Severe dysmenorrhea and chronic pelvic pain are the early onset of symptoms which does not get relieved by medical management of pain which arises the suspicion of confirming the diagnosis. Final diagnosis is made after confirming with HPE report of mass which is resected laparoscopically. ACUM is a treatable cause of dysmenorrhea and adequate awareness of the new entity will enable in making the diagnosis early and improves the quality of life of the patient.