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(A) Hematoma at left adnexa connected to left uterine artery; (B) Saccular dilatation of left uterine artery with sign of extravasation of the artery. (C) Embolization on left uterine artery using PVA and gel-foam.
Source publication
Background:
Acquired uterine arteriovenous malformation (AVM) is a rare condition due to traumatic episodes in cesarean section. The patient can suffer from life-threatening hemorrhage or recurrent vaginal bleeding. Establishing this diagnosis is difficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolizat...
Contexts in source publication
Context 1
... transvaginal ultrasound examination, at the left area of cesarean scar, hematoma was seen in a non-homogenous area. It was connected to the left uterine artery branch, then diagnosed as AVMs and planned for TAE ( Figure 3A). Sheath 5F on left common femoral artery was introduced. ...
Context 2
... end of catheter was placed on distal left internal iliac artery. Saccular dilatation of left uterine artery was found with sign of extravasation of the artery, and also hypervascularization and hypertrophy of left uterine artery ( Figure 3B). Embolization was performed on the left uterine artery using PVA and gel-foam. ...
Context 3
... was performed on the left uterine artery using PVA and gel-foam. There was no aneurysm on the post embolization (Figure 3 C). ...
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Citations
... Acquired uterine AVMs have been reported following CD and tend to occur adjacent to the hysterotomy. 17 Uterine AVM is seen as an anechoic multicystic or serpentine mass within the myometrium associated with high flow vascularity on colour Doppler. 12 Mimics of uterine AVM include RPOC and subinvolution of the placental site, which is exceedingly rare. ...
Introduction
With the rise in Caesarean deliveries, complications related to the procedure are increasingly encountered. Sonography has an indispensable role in the assessment of these complications and is often the first-line investigation of choice. Topic Description: Part 1 of this pictorial review summarises the early complications unique to and associated with Caesarean deliveries.
Discussion
Acute haemorrhagic complications include retained products of conception, subfascial and bladder flap haematomas and, rarely, postpartum uterine dehiscence or rupture and iatrogenic vascular complications. Infective complications include puerperal and wound infections. Key sonographic features of these conditions are illustrated. Pitfalls, mimics, limitations and indications for cross-sectional imaging are discussed.
Conclusion
Sound knowledge of the sonographic features of common early complications of Caesarean delivery will facilitate accurate diagnosis, timely management and improved patient outcomes.
... cesarean section [1]. This condition is predominantly related to various forms of iatrogenic trauma such as hysteroscopy, curettage and myomectomy; even normal vaginal delivery could be traumatic enough to cause AVM. ...
... The choice of treatment varies from hormonal treatment (estrogen and progesterone, oral contraceptive, and intrauterine contraceptive devices), open surgical or Transarterial Embolization (TAE). In the past, treatment for symptomatic acquired uterine AVM required hysterectomy [1]. However, endovascular treatment has provided an alternative and less invasive treatment option for patients wishing to preserve fertility [5]. ...
... AVM must be part of the differential diagnosis as a possible cause of persistent bleeding in the puerperium, as well as placenta accreta. MRI is essential for differential diagnosis [1]. ...
Enhanced myometrial vascularity is a rare entity in which an abnormal communication between vessels of the myometrial wall, potentially derived from all pregnancies, increases bleeding risk. Spontaneous regression is possible, but often, it is not foreseeable in which cases it’s better to adopt a waiting behaviour and in which others a treatment is required. We reported three cases of enhanced myometrial vascularity: two occurring after vaginal delivery, and the third one after a scar pregnancy. The first case was successfully treated by embolization, the second one was subjected to curettage complicated by uterine perforation; the third one underwent embolization as well, but subsequently required hysterctomy for persistent methrorragia. As we treated these similar cases in three different ways, we decided to perform a mini review of the literature in the aftermath. Considering literature data, we strongly believe that the detection of peak systolic speed by colour-Doppler ultrasound together with a careful evaluation of clinical symptoms, could be a good guide to the best treatment of each patient.
It is a book about the different advances in clinical research and pathologies. The chapter I authored (Chapter 15) is in my profile available for reading, it is a comprehensive review on neuroplasticity in spinal cord injury and various forms of treatment that are being proposed for it. If you want the complete book, go to the B P International website to get access.
