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Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

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ABSTRACT

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

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(A) Transvaginal gray-scale ultrasonography image of complex-echoic mass with numerous irregular, tubular, anechoic structures in uterus. (B) On color Doppler ultrasonography, anechoic structures generated multi-directional and turbulent flow. (C,D) Contrast-enhanced abdominal computed tomography, specifically axial scan (C) in late arterial phase and coronal scan (D) in delayed phase, reveals approximately 8 cm lesion located in anterior myometrium and endometrial cavity. The lesion had intensely enhanced serpentine-like tubular structures, and was accompanied by markedly engorged parametrial (arrows) and ovarian (arrowhead) veins. (E) Initial left uterine artery angiogram showing hypertrophied uterine artery and contrast filling in abnormal vasculature (arrow) within lesion. (F,G) Super-selective angiograms of fine feeder arising from anterior branch of left internal iliac artery (F) and right round ligament artery (G), obtained 5 days after initial transcatheter arterial embolization revealed residual staining of uterine arteriovenous malformation.
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Figure 1: (A) Transvaginal gray-scale ultrasonography image of complex-echoic mass with numerous irregular, tubular, anechoic structures in uterus. (B) On color Doppler ultrasonography, anechoic structures generated multi-directional and turbulent flow. (C,D) Contrast-enhanced abdominal computed tomography, specifically axial scan (C) in late arterial phase and coronal scan (D) in delayed phase, reveals approximately 8 cm lesion located in anterior myometrium and endometrial cavity. The lesion had intensely enhanced serpentine-like tubular structures, and was accompanied by markedly engorged parametrial (arrows) and ovarian (arrowhead) veins. (E) Initial left uterine artery angiogram showing hypertrophied uterine artery and contrast filling in abnormal vasculature (arrow) within lesion. (F,G) Super-selective angiograms of fine feeder arising from anterior branch of left internal iliac artery (F) and right round ligament artery (G), obtained 5 days after initial transcatheter arterial embolization revealed residual staining of uterine arteriovenous malformation.

Mentions: Transvaginal ultrasonography (US) revealed a large inhomogeneous complex-echoic mass in the uterus. There was no gestational sac in the uterus (Fig. 1A). Subsequent abdominal computed tomography (CT) scans narrowed down the location of the lesion, measuring approximately 8 cm, to the anterior myometrium and endometrial cavity. The lesion manifested numerous irregular, tubular, anechoic structures. These structures generated a multi-directional and turbulent flow on color Doppler US (Fig. 1B). Markedly engorged parametrial and ovarian veins, with early enhancement in the arterial phase, were evident on contrast-enhanced abdominal CT (Fig. 1C, D). Based on the clinical and radiological findings, a presumptive diagnosis was made; uterine AVM accompanied by, early pregnancy or retained products of conception. From clinical experience, gestational trophoblastic disease (GTD) cannot be ruled out definitively. Further diagnosis and treatment options were discussed with the patient. Neither curettage nor surgical biopsy, including hysterectomy, was suitable for this patient due to the possibility of fatal vaginal bleeding. For this reason, an alternative procedure transcatheter arterial embolization (TAE) was applied. The patient received 3 times of 50-mg methotrexate and 5-mg leucovorin prophylactically via intramuscular injection.


Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries
(A) Transvaginal gray-scale ultrasonography image of complex-echoic mass with numerous irregular, tubular, anechoic structures in uterus. (B) On color Doppler ultrasonography, anechoic structures generated multi-directional and turbulent flow. (C,D) Contrast-enhanced abdominal computed tomography, specifically axial scan (C) in late arterial phase and coronal scan (D) in delayed phase, reveals approximately 8 cm lesion located in anterior myometrium and endometrial cavity. The lesion had intensely enhanced serpentine-like tubular structures, and was accompanied by markedly engorged parametrial (arrows) and ovarian (arrowhead) veins. (E) Initial left uterine artery angiogram showing hypertrophied uterine artery and contrast filling in abnormal vasculature (arrow) within lesion. (F,G) Super-selective angiograms of fine feeder arising from anterior branch of left internal iliac artery (F) and right round ligament artery (G), obtained 5 days after initial transcatheter arterial embolization revealed residual staining of uterine arteriovenous malformation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120079&req=5

Figure 1: (A) Transvaginal gray-scale ultrasonography image of complex-echoic mass with numerous irregular, tubular, anechoic structures in uterus. (B) On color Doppler ultrasonography, anechoic structures generated multi-directional and turbulent flow. (C,D) Contrast-enhanced abdominal computed tomography, specifically axial scan (C) in late arterial phase and coronal scan (D) in delayed phase, reveals approximately 8 cm lesion located in anterior myometrium and endometrial cavity. The lesion had intensely enhanced serpentine-like tubular structures, and was accompanied by markedly engorged parametrial (arrows) and ovarian (arrowhead) veins. (E) Initial left uterine artery angiogram showing hypertrophied uterine artery and contrast filling in abnormal vasculature (arrow) within lesion. (F,G) Super-selective angiograms of fine feeder arising from anterior branch of left internal iliac artery (F) and right round ligament artery (G), obtained 5 days after initial transcatheter arterial embolization revealed residual staining of uterine arteriovenous malformation.
Mentions: Transvaginal ultrasonography (US) revealed a large inhomogeneous complex-echoic mass in the uterus. There was no gestational sac in the uterus (Fig. 1A). Subsequent abdominal computed tomography (CT) scans narrowed down the location of the lesion, measuring approximately 8 cm, to the anterior myometrium and endometrial cavity. The lesion manifested numerous irregular, tubular, anechoic structures. These structures generated a multi-directional and turbulent flow on color Doppler US (Fig. 1B). Markedly engorged parametrial and ovarian veins, with early enhancement in the arterial phase, were evident on contrast-enhanced abdominal CT (Fig. 1C, D). Based on the clinical and radiological findings, a presumptive diagnosis was made; uterine AVM accompanied by, early pregnancy or retained products of conception. From clinical experience, gestational trophoblastic disease (GTD) cannot be ruled out definitively. Further diagnosis and treatment options were discussed with the patient. Neither curettage nor surgical biopsy, including hysterectomy, was suitable for this patient due to the possibility of fatal vaginal bleeding. For this reason, an alternative procedure transcatheter arterial embolization (TAE) was applied. The patient received 3 times of 50-mg methotrexate and 5-mg leucovorin prophylactically via intramuscular injection.

View Article: PubMed Central - PubMed

ABSTRACT

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

No MeSH data available.


Related in: MedlinePlus