Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management

Timmerman, Dirk; Bosch, T. Van den; Peeraer, Karen; Debrouwere, Ellen; Schoubroeck, Dominique Van; Stockx, L; Spitz, Bernard

doi:10.1016/s0301-2115(00)00443-7

Cited by 167 publications

(221 citation statements)

References 31 publications

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“…There are reported cases in which residual placental tissue complicated the diagnosis of uterine vascular malformation [9]. Care needs to be taken before diagnosing AVMs during pregnancy and after abortion.…”

Section: Discussionmentioning

confidence: 99%

Managing Uterine Arteriovenous Malformation (AVM) Is Like Dealing with Raging Wildfire Awaiting a Spark: Better Be Extremely Cautious & Be Ready With Countermeasures like Uterine Artery Embolization (UAE)

Shintre¹

2017

OGIJ

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Fewer than 100 cases of uterine arteriovenous malformation are reported which can cause life-threatening torrential hemorrhage. Prompt diagnosis and treatment are necessary with keeping differential diagnosis of retained products of conception and gestational trophoblastic disease in mind in cases of postpregnancy or post-abortal arteriovenous malformation. We report a case of 27 year old young nullipara female who presented with post-abortal bleeding caused by uterine arteriovenous malformation and retained products of conception. Doppler and MRI results were inconclusive about exact nature of lesion. With uterine artery embolization facilities kept ready, evacuation of retained products was carried with utmost care under ultrasonography guidance. Still it caused torrential life-threatening bleeding which was successfully tackled by uterine artery embolization with an added advantage of preserving her future fertility.

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Section: Discussionmentioning

confidence: 99%

Managing Uterine Arteriovenous Malformation (AVM) Is Like Dealing with Raging Wildfire Awaiting a Spark: Better Be Extremely Cautious & Be Ready With Countermeasures like Uterine Artery Embolization (UAE)

Shintre¹

2017

OGIJ

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“…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.…”

Section: Discussionunclassified

“…Al aplicar Doppler-color, en las zonas anecoicas, se visualiza el ovillo vascular, con flujo multidireccional, de alta velocidad y baja resistencia, que producen imagen de mosaico vascular. Este ovillo se presenta en el 95% de los casos de las formas adquiridas (1,2,7,9).…”

Section: Discussionunclassified

“…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).…”

Section: Discussionunclassified

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Malformación arteriovenosa uterina: A propósito de un caso

Agustí

Bordes

Barrachina

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENPaciente de 37 años que acudió a urgencias por metrorragia, G3P1A2, el último de ellos un aborto tardío en gestación gemelar monocorial biamniótica de 20 semanas hacía dos meses. En la ecografía destaca en zona miometrial un área de marcada vascularización de 67 x 45 mm. Tras descartar proceso residual gestacional y ante la sospecha de malformación arteriovenosa uterina se solicitó resonancia magnética nuclear y angiotac, tras confirmar la malformación vascular se programó para embolización de ambas arterias uterinas con el fin de preservar la fertilidad. PALABRAS CLAVES: Malformación arteriovenosa uterina, metrorragia, embolización arterias uterinas, malformación vascular SUMMARYA 37-year-old patient came to the emergency due to metrorrhagia, G3P1A2, the last of them a late abortion in a 20 weeks monochorionic diamniotic twin pregnancy two months ago. Ultrasound revealed an intramiometrial area of 67 x 45 mm with increased vascularization area. A diagnosis of an arteriovenous malformation was considered. In order to confirm the diagnosis pelvic magnetic resonance and angiogram was performed. Once the vascular malformation was confirmed the patient was scheduled for transcatheter arterial embolization in order to preserve fertility.KEY WORDS: Arteriovenous uterine malformation, metrorrhagia, uterine artery embolization, vascular malformation INTRODUCCIÓNLa malformación arteriovenosa uterina (MAVU), también conocida como fístula arteriovenosa o aneurisma cirsoide es una causa rara de sangrado genital (1,2). A pesar de que no han sido publicados un gran número de casos, se piensa que esta entidad esta subdiagnosticada, ya que puede cursar de forma asintomática e incluso presentar resolución espontánea sin precisar tratamiento (3-7).El propósito de este caso es recordar la existencia de esta patología, la cual presenta un diagnósti-co sencillo mediante ecografía-Doppler. Es importante un diagnóstico precoz de la MAVU, ya que de esta forma es posible iniciar tratamiento médico, y en el caso de precisar tratamiento quirúrgico, poder

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“…Areas of enhanced vascularity can be seen at the site of the placental bed (resembling uterine vascular abnormalities) in the early postpartum period and they usually disappear within 6 weeks spontaneously 5 . However, when uterine vascular abnormalities are associated with persistent trophoblastic disease 6 , retained products of conception 5 -7 , or instrumentation of the uterine cavity 6,7 , the time interval from the last pregnancy or dilatation and curettage to the detection of uterine vascular abnormality is longer, with a median of 6 weeks in one study 6 and an average of 7.6 weeks in another 7 . In these circumstances, the uterine vascular changes may have persisted as a result of retained products, enhanced or arisen in the case of uterine trauma.…”

Section: Figurementioning

confidence: 99%