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Case Reports
. 2017 Jun;90(1074):20160913.
doi: 10.1259/bjr.20160913. Epub 2017 May 25.

Ultrasound-guided transvaginal thrombin injection of uterine arteries pseudoaneurysms

Cristina Ros  1 , Daniel Barnes  2 , Anna Fervienza  1 , Gabriella Oses  3 , Juan L Alcázar  4 , Sergio Martínez-Román  1 , Àngels Rovirosa  3 , Francisco Carmona  1 , Fernando Gómez  2
Affiliations
Case Reports

Ultrasound-guided transvaginal thrombin injection of uterine arteries pseudoaneurysms

Cristina Ros et al. Br J Radiol. 2017 Jun.

Abstract

Objective: To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization.

Methods: Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm3 of thrombin (Tissucol®; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped.

Results: We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2).

Conclusion: Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.

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Figures

Figure 1.
Figure 1.
Contrast-enhanced abdominopelvic multidetector CT in the arterial phase. Volume rendering showing the pelvic vascular anatomy. Uterine artery (black arrowhead) arises from internal iliac artery (black arrow). A pseudoaneurysm (white arrowhead) originating from the left uterine artery is observed.
Figure 2.
Figure 2.
(a) Longitudinal plane of the cervix obtained by transvaginal ultrasound. The pseudoaneurysm is identified as an anechoic mass with strong Doppler signals with the yin-yang Doppler sign, reflecting the turbulent flow inside the pseudoaneurysm (white arrow). (b) Longitudinal plane of the cervix obtained by transvaginal ultrasound performed after the treatment with thrombin, where the yin-yang Doppler sign (pseudoaneurism) is no longer patent (white arrow). (c) Contrast-enhanced pelvic CT in the arterial phase. Note the hyperdense lesion in the uterus (white arrow), which was isodense in portal and delayed phases (not shown) consistent with uterine pseudoaneurysm. (d) Contrast-enhanced pelvic CT in the arterial phase performed after the treatment with thrombin, where the pseudoaneurism is no longer patent (white arrow), showing a correct embolization.
See this image and copyright information in PMC

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