Open Access

Uterine arterio-venous malformation

  • Maxence Dorez1Email author,
  • Jérôme Delotte1,
  • Sébastien Novellas2,
  • Patrick Chevallier2 and
  • André Bongain1
International Journal of Emergency Medicine20103:219

DOI: 10.1007/s12245-010-0219-3

Received: 11 May 2010

Accepted: 1 July 2010

Published: 21 August 2010

A 26-year-old patient presented at the emergency department because of uterine bleeding for the previous 3 days. She had undergone voluntary termination of pregnancy by curettage 2 months before. Upon clinical examination, metrorrhagia was moderate, with heart rate: 90/min, blood pressure: 110/80 mmHg and temperature: 36.9°C.

Intra-vaginal ultrasound examination showed a heterogeneous intra-uterine 30 × 20 mm image suggesting the presence of ovulatory debris following curettage, but the significant vascular supply of this mass upon colour Doppler imaging, revealing a high velocity vascular network, was in favour of an uterine arterio-venous malformation (AVM) [1, 2]. The diagnosis was confirmed upon arterial computed tomography showing the UAVM was located in the portion joining the uterine body and fundus and mainly supplied by the left uterine artery.

Treatment consisted in selective embolization of the UAVM [3, 4]. There were no complications or any further bleeding (Figs. 1, 2 and 3).
Fig. 1

Ultrasonography: heterogeneous intra-uterine image

Fig. 2

Colour Doppler ultrasonography: hypervascularisation

Fig. 3

Arterial CT scan: left uterine arterio-venous malformation

Metrorrhagia is a frequent motive of presentation at the emergency department and often leads to curettage as uterine retention is the common diagnosis. Performing colour Doppler imaging in such a context may reveal the presence of an AVUM, a situation in which curettage could lead to massive and potentially fatal haemorrhage through direct vascular trauma [5].

Declarations

Conflict of interest

None

Authors’ Affiliations

(1)
Obstetrics and Gynecology Unit Archet II, University Hospital of Nice
(2)
Imaging Unit Archet II, University Hospital of Nice

References

  1. Polat P, Suma S, Kantarcy M, Alper F, Levent A (2002) Color Doppler US in the evaluation of uterine vascular abnormalities. Radiographics 22:47–53PubMedView ArticleGoogle Scholar
  2. Timmerman D, Van den Bosch T, Perraer K, Debrouwere E, Van Schoubroeck D, Spitz B (2000) Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management. Eur J Obstet Gynecol Reprod Biol 92:171–178PubMedView ArticleGoogle Scholar
  3. Grivell RM, Reid KM, Mellor A (2005) Uterine arteriovenous malformations: A review of the current literature. Obstet Gynecol Surv 60(11):761–767PubMedView ArticleGoogle Scholar
  4. Timmerman D, Waters J, Van Calenbergh S, Van Schoubroeck D, Maleux G, Van den Bosch T et al (2003) Color Doppler imaging is a valuable tool for the diagnosis and management of uterus vascular malformations. Ultrasound Obstet Gynecol 21:570–577PubMedView ArticleGoogle Scholar
  5. Halperin R, Schneider D, Maymom R, Peer A, Pansky M, Herman A (2007) Arteriovenous malformation after uterine curettage: a report of three cases. J Reprod Med 52(5):445–449PubMedGoogle Scholar

Copyright

© Springer-Verlag London Ltd 2010

Advertisement