Genital tract cavernous hemangioma as a rare cause of postpartum hemorrhage

Abstract

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.

Keywords: Hemangioma, cavernous; Postpartum hemorrhage; Transarterial embolization.

Fig. 1. (A) Pelvic magnetic resonance imaging finding of vaginal hemangioma. A high signal globular lesion in the left lower vaginal wall is seen on T2 fat suppression image (arrow). It extends from the vulva to the mons pubis longitudinally, and from the left lateral pelvic wall to the median vaginal wall transversely. (B) Microscopic finding of the vaginal wall. A medium power field view of the vaginal wall reveals aggregates of large, thin-walled vessels lined by flattened endothelial cells and containing red blood cells (H&E, ×100). H&E, hematoxylin and eosin.

Fig. 2. Left vaginal artery embolization. (A) Coiled vascular structure and extravasation of contrast (arrow) are seen in the left vaginal arteriography. (B) Uterine arteriography shows devascularization of the left vaginal artery after Gelfoam embolization.