A case report of Ggeneralized uterine arteriovenous malformation after molar pregnancy in an infertile woman

Abstract

Background: Uterine arteriovenous malformation (UAVM) is a rare vascular condition in reproductive age presented mostly with bleeding. Although this malformation is infrequent, it is potentially life-threatening. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method.

Case: The case is a 30-yr-old woman with a history of eight-yr infertility.following intrauterine insemination treatment, she had a molar pregnancy. Despite methotrexate treatment, there was persistent vaginal bleeding. Assessment of this patient was done with transvaginal sonography and color Doppler. According to suspicious appearances, angiography was planned for confirmation of UAVM.

Conclusion: UAVM is one of the molar pregnancy complications. The first step for diagnosis of UAVM is transvaginal ultrasonography and color Doppler assessment. Embolization is the best treatment for women who intend to preserve fertility.

Keywords: Arteriovenous malformation; Color doppler ultrasonography; Embolization; Molar pregnancy.

Figure 1

Transverse transvaginal ultrasound (TVUS) shows multiple small anechoic spaces in the anterior myometrium producing a "spongy" myometrial echotexture

Figure 2

A (Sagittal view) and 2 B (Transverse view). Color Doppler ultrasound in this case shows a mosaic flow within the tubular structure with color aliasing

Figure 3

Spectral Doppler ultrasound shows high velocity and low-resistance flow with little variation between systolic and diastolic velocities, compatible with a uterine AVM

Figure 4

A, B. Enlargement of right uterine arteries has been showed and all typical angiographic findings of uterine confirmed AVMs.