Doppler sonography and 3D CT Angiography of Acquired Uterine Arteriovenous Malformations: Report of Two Cases

Abstract

Uterine Arteriovenous Malformations (AVMs) are rare but life threatening causes of abnormal vaginal bleeding. Accurate clinical and radiological diagnosis is essential because uterine instrumentation that is often used for management of other sources of abnormal bleeding, can lead to massive hemorrhage. Timely diagnosis and early proper treatment can markedly reduce the associated disease mortality. Ultrasound with colour and spectral doppler is the initial imaging modality of choice. Three-dimensional computed tomography (CT) angiography can determine the actual extent of the vascular malformation and helps in pre-interventional planning noninvasively. Uterine AVM can be either congenital or acquired in nature with latter being more common. We hereby report two cases of acquired AVMs diagnosed by color doppler sonography and confirmed by three-dimensional CT angiography. Both the cases reported here had previous history of dilation and curettage for abortion. Clinically one patient presented with profuse uterine bleeding and another with meno-metrorrhagia and both cases underwent surgical removal of uterus.

Uterine arteriovenous malformation — diagnosis and management

“…These lesions have been predominantly reported in women of reproductive age, but very rarely in women who have never been pregnant [6]. Acquired AVMs are distinguished by multiple connections of varying size between the arteries and veins in the same proximity [6,7]. Histologic examination reveals multiple small arteriovenous fistulae between the intramural arterial branches and the myometrial venous plexuses [4].…”

“…when compared to CT angiography). The role of three-dimensional CT is to define the extent of involvement, to rule out extrauterine involvement, to differentiate between congenital and acquired uterine AVM, and to identify the feeding vessels or uterine arteries [7,21]. CT angiography reduces the radiation dose, study time, and contrast required to perform the procedure in patients planned for embolization.…”

“…In patients scheduled to undergo surgery, it could be useful for orient the surgeon to the anatomy [22]. CT angiography is preferred in unstable patients with heavy bleeding or those who have contraindications for undergoing MRI [7].…”

Female Pelvic Vascular Malformations

“…Most patients are reproductive age women with a history of spontaneous abortion, gestational trophoblastic disease, or infection. [32][33][34][35] Most AVMs have no familial association, but a few mutations have been examined including phosphatase and tensin (PTEN) in Bannayan-Riley-Ruvalcaba or Cowden syndrome. 36 RASA-1 mutation has been identified in Parkes-Weber and capillary malformation-arteriovenous malformation (CM-AVM).…”

“…A negative B-HCG should distinguish these findings from abnormal placentation or gestational trophoblastic disease. 29,32,35,[41][42][43] CT angiography (CTA) or MRI may be performed to identify the extent of the lesion. CTA and MRA help identify the arterial feeders and venous drainage as well as the absence of an associated mass.…”