Transvaginal 3D HD-flow in diagnosis of uterine arteriovenous malformation

Abstract

‘‘Uterine arteriovenous malformation (AVM) is a rare lesion with a considerable risk potential. The clinical presentation varies from no signs, to various degrees of menorrhagia, to massive life-threatening vaginal bleeding; Clinical suspicion is essential for a prompt diagnosis and treatment’’ [1]. Conventional two-dimensional (2D) color/ power Doppler sonography is a valuable and noninvasive modality for the definitive diagnosis of pelvic AVM in clinical practice [2, 3]. Moreover, three-dimensional (3D) color/power Doppler sonography has the potential to provide an improved visualization and recognition of pelvic AVM [4–6]. ‘‘High definition-flow (HD-flow) is a bi-directional power Doppler technique that delivers high-definition axial resolution and increased sensitivity for imaging small vessels. In addition, it reduces the spatial overlap of tissue signals by the application of small sample volumes, and provides optimal clutter elimination with adaptive wall filtering. 3D HD-flow is unique for 3D reconstruction of fetal vascularities in the whole body’’ [7]. We present our experience of uterine AVM with heavy vaginal bleeding following uterine curettage, diagnosed by employing transvaginal 3D HD-flow with multiplanar and angiographic displays. A 25-year-old Japanese woman, gravida 5, para 0, was referred to our university hospital because of an episode of sudden episodic profuse vaginal bleeding following her menses. She had undergone dilatation and curettage due to first-trimester missed abortion 6 weeks previously. Urine hCG was negative on the visit. Transvaginal 2D sonography depicted an ill-defined, inhomogeneous lesion involving the endometrial and subendometrial tissues with variously sized hypoechoic cysts (Fig. 1). Transvaginal 2D HD-flow revealed a hypervascular lesion in the myometrium involving the endometrial and subendometrial tissues