Successful Treatment of Uterine Arteriovenous Malformation due to Uterine Trauma

Abstract

Uterine arteriovenous malformation (AVM) is defined as abnormal and nonfunctional connections between the uterine arteries and veins. Although the patients typically present with vaginal bleeding, some patients may experience life-threatening massive bleeding in some circumstances. The treatment of choice depends on the symptoms, age, desire for future fertility, and localization and size of the lesion; however, embolization of the uterine artery is the first choice in symptomatic AVM in patients at reproductive age with expectations of future fertility. We report a case of acquired AVM (after D/C) with an extensive lesion, which was successfully treated with bilateral uterine artery embolization (UAE).

Figure 1

(a) Ultrasound image just before D/C shows 9-week fetus with no cardiac activity and there is no sign of uterine AVM. (b) Sagittal endovaginal image of the uterus shows 60 × 60 × 56 mm (103 cm³) hyperechogenic and heterogeneous mass lesion located in the anterior wall of the uterus and extending laterally at the left. (c) Color Doppler image shows multiple tortuous vessels.

Figure 2

(a) Right/left internal iliac uterine artery angiography showing opacification of a slightly enlarged right uterine artery and hypervascular mass in the uterus. (b) Postembolization angiographic image.

Figure 3

A repeat transvaginal ultrasound and color Doppler were done two months later; (a) the lesion was measuring 61 ∗ 46 ∗ 52 mm (77 cm³) and (b) revealed no blood flow.