Abstract
Arteriovenous malformations (AVM) are abnormal connections between arteries and veins without a capillary bed, creating high- and low-flow areas that are prone to bleeding. Uterine AVMs can be congenital or acquired with an incidence of 0.1%. Acquired cases are usually caused by uterine instrumentation, trauma, infection, or gestational trophoblastic disease. Patients typically present with sudden onset of heavy vaginal bleeding. Diagnosis is made using angiography, ultrasound, computerized tomography, or magnetic resonance imaging. After patients are stabilized, management depends on their desire for future fertility and may include hysterectomy or endovascular embolization.We present the case of a 16-year-old G1P0010 female with recurrent vaginal bleeding caused by a uterine AVM. To preserve the patient’s fertility, a selective embolization approach was employed using microcoils and gel foam. This case highlights a unique treatment option for uterine AVMs in patients who desire fertility preservation. Additionally, we review the diagnostic imaging and treatment options for uterine AVMs.
Highlights
Abnormal uterine bleeding (AUB) is defined as menstrual bleeding that is abnormal and/or irregular in duration, frequency, or intensity [1]
We present the case of a 16-year-old G1P0010 female with recurrent vaginal bleeding caused by a uterine arteriovenous malformation (AVM)
We present the case of a young female patient with uterine AVM who was successfully treated with a fertility-preserving approach using embolization
Summary
Abnormal uterine bleeding (AUB) is defined as menstrual bleeding that is abnormal and/or irregular in duration, frequency, or intensity [1]. Transvaginal ultrasonography (TVUS) was obtained which revealed a slightly thickened endometrium with increased vascularity and a hypoechoic, hypervascular focus in the endometrium This led to a concern for retained products of conception or an AVM secondary to prior uterine surgeries (Figure 1). A pelvic MRI was obtained which demonstrated an enhancing 8 × 4 mm polypoid structure within the endometrial cavity (Figure 2) These findings were suggestive of an AVM or post-traumatic changes from the patient’s prior uterine surgeries. Prior to the patient’s diagnostic angiogram, she experienced an episode of vaginal bleeding with the passage of a medium-sized clot and her hemoglobin dropped to 5.9 g/dL She was transfused with two units of packed red blood cells prior to the procedure. Her hemoglobin was found to be stable at 9.3 g/dL upon discharge from the hospital
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