Uterine artery pseudoaneurysm hidden behind septic abortion: Pseudoaneurysm without preceding procedure

Abstract

Uterine artery pseudoaneurysm (UAP) can occur after cesarean section or traumatic delivery, usually manifesting as postpartum hemorrhage. Here we report a patient with UAP possibly caused by septic abortion. She had high fever and bleeding with positive urine pregnancy test. We diagnosed this condition as septic abortion. Ultrasound revealed an intrauterine echogenic mass and color Doppler revealed swirling blood flow within the mass. Contrast-enhanced computed tomography showed a heterogeneously enhanced intrauterine mass. Selective internal iliac artery angiography revealed contrast medium within the mass immediately after medium injection. Bilateral uterine artery embolization was performed, after which medium no longer accumulated in the uterus, and hemostasis was achieved, confirming the diagnosis as UAP. Antibiotic treatment ameliorated the infection and the uterine content was expelled and absorbed. UAP can occur even without preceding procedures and may manifest abortive, and not postpartum, hemorrhage. UAP may be hidden behind septic abortion.

Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolisation

“…A UAP is an extraluminal collection of blood that communicates with the main vessel through a defect in the arterial wall 7. It can mimic and mask other entities, such as adnexal masses,8 septic abortion9 or endometritis, as we have reported here. It is thought that UAP develops as a complication of vascular injury resulting from inflammation, trauma or iatrogenic procedures 10 11…”

Cesarean scar pregnancy and uterine artery pseudoaneurysm: preceding or coexisting?

“…The present authors, to their knowledge, were the first to describe "UAP without preceding event": it was UAP caused by septic abortion [6]. Infection may have caused vessel injury, leading to UAP.…”

Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm

“…Underlying vascular abnormality, strong shear or acute stretching of the artery due to precipitous delivery, and infectionrelated damage to the adjacent artery wall have all been proposed as the potential mechanisms (Matsubara et al, 2014a). Retrospectively, there were several risk factors for UAP formation in our case including the prior CS, a relatively precipitous labor, and minor laceration of the cervix.…”