Use of three‐dimensional power doppler sonography in the diagnosis of uterine arteriovenous malformation and follow‐up after uterine artery embolization: Case report and brief review of literature

Abstract

Arteriovenous malformations (AVM) of the uterus can cause life-threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37-year-old woman had increasingly severe vaginal bleeding for 15 days. Serum β-hCG was elevated. Two-dimensional transvaginal ultrasound suggested retained products of conception. Before dilation and curettage (D&C), color Doppler and three-dimensional (3D) power Doppler demonstrated findings indicative of uterine AVM. A bilateral uterine artery embolization was performed without complications. Three months after uterine artery embolization, 3D power Doppler ultrasonography found complete resolution of the AVM. This case illustrates the importance of assessing both gray-scale and 3D power Doppler, and the ability of postprocedure Doppler to assess resolution.

Imaging of Pregnancy-related Vascular Complications

“…As a relatively rare, although likely underdiagnosed (62), cause of abnormal uterine bleeding, uterine arteriovenous malformation (UAVM) is a pathologic capillary shunt via direct connection of the arteries and veins (63). The malformations result from a proliferation of collateral vascularization and multiple small fistulas due to retained trophoblasts.…”

Successful management of abnormal uterine bleeding from uterine arteriovenous malformations with progesterone in postabortal patients

“…Various imaging modalities have been employed to diagnose AVMs that include, ultrasonography, contrast enhanced CT (CECT), MRI, saline sono‐hysterography and angiography. As angiography is invasive one, ultrasonography (particularly transvaginal) with color Doppler has been emerged as the preferred modality for diagnosis, and follow‐up of these lesions . Various treatment modalities are employed in the management of AVMs, including conservative (monitoring of the lesions for spontaneous regression through ultrasonography), medical (use of drugs), embolization or surgery .…”

“…Though rare, they have the potential to cause irregular or torrential bleeding which may be at a time life threatening. 2,3 The incidence of acquired AVM might have been gradually increasing in recent years because of increase in interventions (those following pregnancy, caesarean section, curettage and abortion). 1,2 Sometime they are asymptomatic and may undergo spontaneous resolution.…”

“…As angiography is invasive one, ultrasonography (particularly transvaginal) with color Doppler has been emerged as the preferred modality for diagnosis, and follow-up of these lesions. 3 Various treatment modalities are employed in the management of AVMs, including conservative (monitoring of the lesions for spontaneous regression through ultrasonography), medical (use of drugs), embolization or surgery. 4 Emergency uterine artery embolization (UAE) is generally performed to stop the torrential bleed but is associated with significant risks of ovarian insufficiency and placental abnormalities during subsequent pregnancies.…”

Uterine Arteriovenous Malformation After Molar Pregnancy: A Case Report and Review of Literature

“…The first choice of imaging studies is pelvic sonography, particularly use of Doppler, followed by MRI and angiography. It appears that uterine artery embolization is the most common treatment of AVM although successful result of conservative treatment has also been reported (2). Tsai reported an effective embolization of large molar AVM, which led to successful term pregnancy.…”