Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

Abstract

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

Keywords: Arteriovenous malformations; Beta-human chorionic gonadotropin; Transcatheter arterial embolization.

Fig. 1. (A) Transvaginal gray-scale ultrasonography image of complex-echoic mass with numerous irregular, tubular, anechoic structures in uterus. (B) On color Doppler ultrasonography, anechoic structures generated multi-directional and turbulent flow. (C,D) Contrast-enhanced abdominal computed tomography, specifically axial scan (C) in late arterial phase and coronal scan (D) in delayed phase, reveals approximately 8 cm lesion located in anterior myometrium and endometrial cavity. The lesion had intensely enhanced serpentine-like tubular structures, and was accompanied by markedly engorged parametrial (arrows) and ovarian (arrowhead) veins. (E) Initial left uterine artery angiogram showing hypertrophied uterine artery and contrast filling in abnormal vasculature (arrow) within lesion. (F,G) Super-selective angiograms of fine feeder arising from anterior branch of left internal iliac artery (F) and right round ligament artery (G), obtained 5 days after initial transcatheter arterial embolization revealed residual staining of uterine arteriovenous malformation.

Fig. 2. Three months after undergoing transcatheter arterial embolization, follow-up transvaginal ultrasonography confirmed complete resolution of the uterine arteriovenous malformation.