Mullerian anomalies present with a variety of clinical manifestations including infertility (Dysmorphic/T-shaped uterus), repeated first-trimester spontaneous miscarriages (Septate uterus), fetal growth restriction, fetal malposition, preterm labor, preterm delivery, obstructed or nonprogressive labor, and retained placenta. Paradoxically, a significant number of these anomalies are incidental findings and this creates a dilemma with offering treatment options. An unambiguous label of the type of dysmorphology is central to the solution to this problem. Consequently, attempts are being made to define these better in order to optimize the treatment offered. Ultrasound is one imaging tool that is widely available, economical, lacks radiation and can be achieved rapidly, and is now the first step to diagnosis. Two-dimensional (2D) ultrasound, however, misses a large number of anomalies because it is often impossible to demonstrate a coronal plane. This plane is necessary to delineate the external uterine contour, which is central to labeling a mullerian anomaly. Three-dimensional (3D) US is recommended for the diagnosis of mullerian anomalies in symptomatic patients belonging to high-risk groups and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopy should be carried out for patients with suspected complex malformations or in diagnostic dilemmas. Adolescents with symptoms should be thoroughly assessed with 2D and 3D ultrasound, MRI, and with endoscopy.