Uterine arteriovenous malformation

Abstract

Uterine arteriovenous malformation (AVM) is a little known condition of which, to date, very few cases have been described. It has a very diverse symptomatology, even though in most cases, it is diagnosed during a severe and acute haemorrhagic event. Its treatment can vary from expectant management to hysterectomy; however, current evidence suggests that the embolisation of uterine arteries is the most effective approach, especially if fertility is to be preserved. We present a case report classified as AVM, with additional images that show the appearance of this pathology in a short span of time. This case has a number of peculiarities: unusual persistence of human chorionic gonadotropin hormone (β-HCG), asymptomatic patient, quick establishment of the lesion and its duration with unchanging characteristics and finally its spontaneous resolution without further consequences. This entity shows an aetiopathogenesis, that is, not well established or described. We discuss its physiopathology and aetiopathogenesis.

Malformación arteriovenosa uterina: A propósito de un caso

“…La clínica derivada de esta patología es muy diversa, pudiendo permanecer silente en un número variable de casos. En la mayoría de los casos sintomáticos se presenta como una alteración del patrón de sangrado (goteo persistente, metrorragia) o bien puede presentarse como hemorragia masiva con riesgo vital (1)(2)(3)5,6,8).…”

“…Ante la presencia de un sangrado genital anó-malo es necesario la realización de una ecografía-Doppler vía transvaginal, la cual constituye una herramienta suficiente para diagnosticar la malformación (3)(4)(5)(7)(8)(9). En la ecografía se observa de forma típica un miometrio de aspecto heterogéneo, con zonas anecoicas irregulares en su interior que pueden confundir con zona de adenomiosis.…”

“…El tratamiento varía en función de la clínica y de la estabilidad hemodinámica de la paciente, desde manejo expectante hasta histerectomía, sin embargo el tratamiento más eficaz es la embolización de las arterias uterinas, cuya principal ventaja frente a la histerectomía es la preservación de la fertilidad (1,3,4,7,9,10). Es importante recordar que el legrado está contraindicado ya que suele agravar el sangrado pudiendo causar la muerte (2,5,6).…”

Spontaneous Regression of Uterine Arteriovenous Malformations with Conservative Management

“…Thus, this condition may have a higher incidence than expected [1]. AVM can be congenital or acquired.…”

Heavy vaginal bleeding, post termination of pregnancy: not always retained products of conception

“…The exact incidence of uterine AVM is not known but fewer than 100 cases have been reported in the literature. [1][2][3] The usual presentation to the emergency department of a uterine AVM is heavy vaginal bleeding, usually with a background of intrauterine instrumentation like curettage or caesarean section. Historically, uterine AVMS were diagnosed in hysterectomy specimens but with advent of improved imaging facilities, it has been possible to diagnose the AVMs in a much more timely manner rather than just in hysterectomy specimens.…”