A Case Series on Uterine Arteriovenous Malformations: A Life-Threatening Emergency in Young Women

Abstract

Uterine arteriovenous malformation (AVM) is a rare condition, with few cases reported in the literature. Despite being rare, it is a potentially life-threatening condition in women of childbearing age. It should be considered in the differential diagnosis of prolonged or irregular vaginal bleeding, which, otherwise, can lead to critical complications ending up in severe morbidity and mortality. This case series describes four cases of young Asian women aged between 33 and 38 years who presented with irregular vaginal bleeding. Trans-abdominal ultrasound of the pelvis showed increased vascularity with multi-directional blood flow in the uterus. Magnetic resonance imaging (MRI) confirmed an arteriovenous malformation in all cases. All cases remained stable through the diagnostic journey. Embolization of the arteriovenous malformation was performed successfully in three cases and one case was managed conservatively on hormones. Later, two of them conceived within a year and had live births at term. The aim of reporting these cases is to share the common presentation of this condition and our experience in making the diagnosis and treatment of such patients. Although a few cases are reported world over, none was reported earlier from Pakistani Asian women.

Arteriovenous Malformation of the Uterus in a 41-Year-Old Woman Presenting as Uterine Bleeding

“…Uterine AVMs were first reported in 1926 [ 1 , 4 ]. These are rare entities with an unknown prevalence, with less than 100 cases documented in the literature [ 4 - 5 ]. An AVM of the uterus is most commonly a fistulous connection between the branches of the uterine artery and the myometrial venous plexus, which bypasses the normal intervening capillary network [ 1 ].…”

Uterine arteriovenous malformation: A rare yet perilous entity.

“…The conservative approach, including hormonal medications, i.e., combined hormonal contraceptives 12,13 , progesterone, Gonadotropinreleasing hormone agonist (GNRHa4) 14,15 , danazol and methylergonovine maleate 16 are feasible for hemodynamically stable patients with mild or irregular vaginal bleeding. Literature review revealed many case reports supporting the successful use of hormonal agents in regression of AVM [12][13][14][15][16] . Downregulation of estrogen secretion increased uterine arterial resistance and decreased uterine blood flow is postulated as the possible mechanism of action.…”

Uterine Arteriovenous Malformation: A Pictorial Review of Diagnosis and Management

“…The radiological features are summarized in Table 1. 2,19,25,[54][55][56][57][58][59][60][61][62] Table 1. Common Imaging Findings of Uterine Arteriovenous Malformation (UAVM).…”

“…Common Imaging Findings of Uterine Arteriovenous Malformation (UAVM). 2,19,25,[54][55][56][57][58][59][60][61][62]…”

“…MRA with 3-dimensional (3D) and dynamic pulse sequences with multiplane reconstruction and timing resolution play an important role in the evaluation of UAVMs (Figures 7-11). 19,[58][59][60]…”