Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage

Abstract

Uterine arteriovenous vascular malformation (UAVM) is a disease that causes excessive bleeding. The symptoms do not subside without proper treatment and this can lead to life-threatening situations. The correct diagnosis of UAVM can be complicated if the patient's uterus did not completely discharge everything during abortion (in broader terms, retaining remnants of the products of conception). In this case, Doppler ultrasonography and computed tomography angiography with 3-dimensional rendering were used to analyze the cause of bleeding and provide proper treatment of this patient. Then, uterine artery embolization, dilatation, and curettage were performed safely and successfully. The patient no longer had symptoms of vaginal spotting during the planned follow up care. UAVM is uncommon; however, if reproductive-age women show repeated abnormal vaginal bleeding after dilatation and curettage, a diagnosis of UAVM must be considered based on the medical history and examination.

Keywords: Arteriovenous malformation; Ultrasonography; Uterine artery; Vaginal bleeding.

Fig. 1. (A) Transvaginal US shows heterogenous endometrium with an internal echolucent structure. (B) Color Doppler US images reveal multidirectional flow within the posterior wall of the endometrium. (C) Spectral flow Doppler shows high velocity flow pattern (PSV >60 cm/s). (D, E) CT scan shows prominent vascularity within thickened posterior uterine fundus and high enhanced lesion. (F, white arrow) CT angiography with 3D rendering shows the hypervascular tangles of tortuous vessel. (G) After 2 months UAE, follow-up transvaginal US demonstrated complete resolution of UAVM and no vascularity within the lesion.

PSV, peak systolic velocity; CT, computed tomography; 3D, 3-dimensional; UAE, uterine artery embolization; UAVM, uterine arteriovenous vascular malformation.

Fig. 2. (A) Left uterine artery. (B) Right uterine artery. Angiography shows UAVM with an early contrast vein filling. (C) Embolization of the AVM was completed.

UAVM, uterine arteriovenous vascular malformation; AVM, arteriovenous vascular malformation