Abstract
A 37-year-old female, with a history of three caesarean sections, presented to our emergency department with conspicuous vaginal bleeding. Duplex ultrasound revealed a uterine mass with high blood flow. Abdominal contrast-enhanced multi-detector computed tomography demonstrated a heterogeneously enhanced mass in the uterus with dilated uterine arteries, multiple intrauterine tortuous vessels, early enhancement of the right iliac vein – inferior vena cava and right uterine vein (Panel A). Based on clinical and imaging findings, an acquired uterine arteriovenous malformation (UAVM) was considered. After multidisciplinary agreement, the patient underwent urgent digital subtraction angiography (Panel B) with uterine artery embolization to decrease the ongoing vaginal bleeding and reduce the possible successive risk of intraoperative blood loss. On the following day, a hysterectomy with total removal of the UAVM was successfully achieved. Pathologic evaluation confirmed the diagnosis of UAVM.
Abdominal contrastenhanced multi-detector computed tomography coronal Volume Rendering Technique that demonstrates the uterine arteriovenous malformation (arrow-head), early of the inferior vena cava(*) and right uterine vein (arrow).
Abdominal digital subtraction angiography that confirms the uterine arteriovenous malformation (arrow-head).
Acquired UAVMs are a rare cause of obstetric hemorrhage. Uterine trauma is the main cause of acquired UAVM, including caesarean section. 1 Treatment options include percutaneous transcatheter arterial embolization (TAE) or surgical management, 2 which can be used individually or together. 3 Therefore, multidisciplinary discussion and collaboration played a key role in the diagnosis and therapy of this UAVM with marked vaginal bleeding.
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Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.