Differential diagnosis and management of placental polyp and uterine arteriovenous malformation: Case reports and review of the literature

Abstract

Postpartum uterine bleeding is not uncommon and is caused by a variety of obstetrical and gynecological disorders, such as retained placenta, dysfunctional bleeding, and endometrial polyps. Placental polyps and uterine arteriovenous malformation are disorders often encountered in cases of abnormal uterine bleeding in the late puerperal period. These patients may experience life-threatening bleeding and require prompt intervention based on the correct differential diagnosis. The optimal treatments for both diseases differ as follows: intrauterine curettage or transcervical resection are chosen for placental polyps, while total abdominal hysterectomy or uterine artery embolization is preferred for uterine arteriovenous malformation since intrauterine curettage or transcervical resection has the risk of massive bleeding. However, since placental polyp and uterine arteriovenous malformation have similar clinical characteristics, it is important to accurately identify and differentiate between them to ensure optimal therapy. We report here cases that were suggestive of placental polyp or uterine arteriovenous malformation. We discuss the differential diagnoses and treatments for both diseases based on a literature review and propose a novel algorithm for managing such patients.

Keywords: arteriovenous malformation; diagnosis; placental polyp; transcervical resection; treatment.

Figure 1.

Imaging results of TV-USG (gray scale (a) and color Doppler (b)) in case 1. Note the (a) polypoid mass (18 mm × 14 mm) with high echoic regions and (b) vascular flow toward the polypoid mass from fundus of the uterus.

Figure 2.

Imaging results of MRI in case 1. Note the (a) polypoid mass projecting into the uterine cavity in the T1-weighted image with (b) non-uniform high intensity in the T2-weighted image.

Figure 3.

Imaging results of three-dimensional CT angiography in case 1. Note the prominent vascular mass with a major vascular supply from the left uterine artery.

Figure 4.

Imaging results of TV-USG in case 2. Note the hypervascular polypoid mass with a feeding artery originating from the fundus.

Figure 5.

Imaging results of CT angiography in case 2. Note the hypervascular mass measuring 3 cm × 3 cm within the uterine cavity with the feeding artery being supplied by the left uterine artery. (a) Axial section (b) Coronal section.

Figure 6.

Imaging results of MRI in case 2. (a) A mass with non-uniform high intensity is observed on the T1-weighted image. (b) The T2-weighted image shows coil formation in the center of the tumor.

Figure 7.

Proposed algorithm for the diagnosis and management of placental polyp and AVM. UAE: uterine artery embolization; TAH: total abdominal hysterectomy; PP: placental polyps; AVM: arteriovenous malformation; TCR: transcervical resection.