Abstract
Background: Uterine arteriovenous malformation (AVM) is a rare, potentially life-threatening cause of abnormal uterine bleeding that can be acquired following a cesarean section. The diagnosis is difficult, often misdiagnosed with retained products of conception and placenta accreta. Transarterial embolization (TAE) is an efficacious and effective method of treating AVM, particularly in patients of reproductive age. Case Report: A 41-year-old, nulliparous woman, started with a history of abnormal uterine bleeding 30 days after a cesarean section. She didn’t have anaemia and beta-human chorionic gonadotropin (beta-hCG) was negative. The transvaginal color Doppler ultrasound showed multiple vascular channels within myometrium showing colored mosaic patterns suggesting AVM, confirmed by Magnetic Resonance Imaging. The patient was referred to perform a Computed Tomography Angiography and right uterine artery embolization without any vascular complications. Conclusion: AVM is a rare consequence of cesarean section but has to be considered in cases of persistent uterine bleeding in the puerperium. Embolization is a safe and effective choice treatment of AVM and an alternative and less invasive option for patients wishing to preserve fertility.
Highlights
arteriovenous malformation (AVM) is a rare consequence of cesarean section but has to be considered in cases of persistent uterine bleeding in the puerperium
We present a case of AVM that was successfully treated by Transarterial embolization (TAE)
AVM could be related to the increased rates of cesarean delivery
Summary
The transvaginal color Doppler ultrasound showed multiple vascular channels within myometrium showing colored mosaic patterns suggesting AVM (Figure 1). These findings were confirmed by Magnetic Resonance Imaging (Figure 2(A) and Figure 2(B)). Angiography after embolization showed satisfactory occlusion of these abnormal vessels, without any vascular complications (Figure 3(D)). She had a history of a small vaginal bleeding 10 days after the procedure. Forty days post-embolization the patient was submitted to a control transvaginal ultrasound which showed no abnormal results. Pelvis Magnetic Resonance Imaging was performed 2 months after the embolization and showed no abnormalities
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