Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases

Abstract

We describe the color Doppler sonographic features of uterine arteriovenous malformations in two cases. In both cases color Doppler imaging demonstrated hypervascularity throughout the arteriovenous malformation. The dominance of pale shades during both systole and diastole represented low-impedance, high-velocity flow within the lesion and a colored mosaic pattern representing turbulent flow was noted. Spectral analysis of the vessels within the lesion confirmed high-velocity flow during both systole and diastole, and a low resistance index. The spectral waveform trace also showed spectral broadening consistent with turbulence and the spectral envelope was irregular. These findings indicated the presence of numerous arteriovenous shunts and marked turbulence within the arteriovenous malformation. Spectral analysis of the venous flow revealed high flow velocities and systolic velocity peaks similar to an arterial pattern. The uterine artery velocity waveforms were characterized by high flow velocity and a low resistance index. The diagnosis of uterine arteriovenous malformation was confirmed by histological examination in both cases. The findings of these two cases suggest that color Doppler sonography may play an important role in the diagnosis of uterine arteriovenous malformations.

Postabortion Doppler Evaluation of the Uterus

“…However, these color and pulsed Doppler findings are also observed in a variety of conditions with arteriovenous shunting, including RPOC, trophoblastic disease, and abnormal placentation. 9,12,13 In our study, the causes of myometrial hypervascularity on postabortion day 10 were pathologically proven RPOC in 61.5% of cases and hydatidiform moles in 15.4%. There was no case of a uterine AVM, and hypervascular uterine lesions completely disappeared in all cases at an average of 16.54 ± 11.06 days (range, 7-48 days) after the second D&C. In the previously reported studies 1,3,4,11,12,14,15 and case reports, 5-7,9,10,16 nearly all AVMs and vascular malformations of the uterus were diagnosed within a few days to several weeks after term delivery, molar pregnancy, or induced or spontaneous abortion.…”

“…[11][12][13] On CDS, a uterine AVM appears as a hypervascular lesion showing high-velocity, lowimpedance flow on spectral analysis. However, these color and pulsed Doppler findings are also observed in a variety of conditions with arteriovenous shunting, including RPOC, trophoblastic disease, and abnormal placentation.…”

Clinical features and characteristics of blood flow of uterine vascular abnormalities

“…To date, several case reports or case series have been presented, and it is known that AVMs are more common in women. 24,[26][27][28] This case series of uterine vascular abnormalities is one of the largest reported, and our preliminary study using vaginal ultrasound showed that AVMs are not rare, with an incidence of 5.6% (61/1100) in normal mature women; however, most of these AVMs were latent cases without pain or atypical bleeding. The complaints in the 61 cases were lower abdominal pain and/or low back pain (3/61, 4.9%) and dysmenorrhea (20/61, 32.8%).…”

Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception

“…It should be mandatory to perform spectral Doppler studies if colour Doppler uptake has been shown on the ultrasound examination. Spectral analysis of the colour Doppler insonated area of the endometrium, in patients with AVMs, shows high flow velocities and systolic velocity peaks, similar to an arterial pattern, which suggests arteriovenous shunting 8 . However very high velocities have also been documented with retained products without AVM(1).…”