Uterine arteriovenous malformations as a rare differential diagnosis of abnormal uterine bleeding: A case report

Abstract

Introduction and importance: Uterine arteriovenous malformations (UAVMs) are rare vascular anomalies caused by abnormal connections between uterine arteries and veins. They can lead to severe bleeding, requiring prompt and accurate diagnosis. Historically treated with hysterectomy, transcatheter vascular embolization has emerged as a fertility-sparing alternative.

Case presentation: A 25-year-old woman with a history of partial molar pregnancy presented with acute pelvic pain and abnormal uterine bleeding. Initial findings suggested an intrauterine pregnancy of uncertain viability. Recurrent bleeding, elevated β-hCG levels, and abnormal Doppler findings raised suspicion of gestational trophoblastic disease. Endometrial aspiration was performed, but bleeding recurred. Further imaging revealed a uterine arteriovenous malformation, confirmed by angiography. The malformation was successfully treated with selective arterial embolization. Histopathology later confirmed a first-trimester miscarriage without evidence of gestational trophoblastic disease.

Clinical discussion: UAVMs can mimic gestational trophoblastic disease due to overlapping clinical signs such as abnormal uterine bleeding and high vascularity Doppler patterns. Diagnosis requires a multidisciplinary approach and imaging expertise. In our case, transvaginal Doppler identified the pathognomonic high-velocity flow pattern, while angiography confirmed the UAVM and enabled immediate treatment. Selective arterial embolization was effective, preserving fertility and aligning with modern management practices.

Conclusion: This case emphasizes the importance of a thorough diagnostic approach in abnormal uterine bleeding. UAVMs should be considered in patients with risk factors. Selective arterial embolization is an effective fertility-sparing treatment, highlighting the value of multidisciplinary care in managing complex gynecological cases.

Keywords: Arterial embolization; Case report; Gestational trophoblastic disease; Uterine arteriovenous malformations.

Fig. 1

Sagittal cut of the uterus by transvaginal ultrasound showing a focal area of hypervascularity within the anterior myometrium, characterized by a mosaic pattern of multidirectional high-velocity flow (red and blue signals). Note the heterogeneous echotexture of the myometrium and the vacant endometrial cavity. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)