ResearchArticle: Acquired Uterine ArteriovenousFistula

Abstract

Background:Vascular anomalies are a new emerging field involving several medical and surgical specialties. Uterine arteriovenous malformation is a rare condition with fewer than 100 cases reported in the literature. Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women of child bearing age. Aim:The purpose of this study is to describe the role of high degree of suspicion and sonographic features of uterineArteriovenousmalformation and to describe the role and clinical outcome after arterial embolization. Color Doppler ultrasound provides a non-invasive method for diagnosing this rare condition. Material &Method: A 37 Year female patient presented with severe abdominal pain and episodes of refractory vaginal bleeding in a surgical set-up masquerading as suprapubic pain. A complete work up of the case was done. Trans abdominal ultrasound of the pelvis showed a moderate sized mass of mixed reflectivity in upper posterior myometrium. Result: The sonographic grey scale findings of uterine Arteriovenous Malformation are nonspecific. The finding was subtle myometrium heterogeneity. Color Doppler sonography showed a tangle of vessels with multidirectional high velocity flow that produced a ‘’Color Mosaic Pattern’’.Spectral Doppler ultrasonography revealed vascular lesion in the posterior wall of uterus near funds in case and increased vascularity of the uterus with prominent vessel seen on the left lateral wall of the uterus. Spectral study showed high velocity, low resistance flow with high diastolic component. Peak systolic velocity was approximately 34.5 cm/s while resistive index was 0.39.The UVAM was classified as stage III.Schobinger staging system. She responded to uterine arterial embolization at higher center Conclusion: Routine use of colorand spectral Doppler sonography allows one to confidently make the correct diagnosis. Transcatheter arterial embolization is an excellent treatment option. Endovaginalsonography should be used to monitor post embolization outcomes. Uterine arteriovenous malformations are more common is essential for prompt diagnosis and treatment.