Imaging spectrum of acquired uterine vascular abnormalities with angiographic correlates, a pictorial review

Abstract

Background Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials. Main text This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates. Conclusion Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.

Enhanced myometrial vascularity and AVM: A review on diagnosis and management

“…Uterine artery pseudo‐aneurysm is an uncommon but potentially life‐ threatening cause of gynecologic hemorrhage. It is an extra luminal blood‐filled sac through a defect in the arterial wall as a rare complication of cesarean section, D&C, hysteroscopy, myomectomy, or ovarian puncture 35 . It has been rarely reported on the basis of severe deep infiltrating endometriosis 36 .…”

“…It has been rarely reported on the basis of severe deep infiltrating endometriosis 36 . It is a blood‐filled outpouching or diverticula contained within the adventitia or surrounding perivascular soft tissue making it different from a true aneurysm which is less common and contains three‐layer arterial wall linings 35 (Figure 2).…”

“…USG shows a cystic structure containing the typical to‐and‐fro or Ying yang pattern flow on Doppler which is connected to the adjacent parent artery. Enhancement pattern, location, the sac size and neck width, the surrounding vascular anatomy and possible active bleeding (showing by contrast extravasation on delayed phase images) can be best evaluated by triple‐phase CT or MR angiography 35 …”

“…It is an extra luminal blood-filled sac through a defect in the arterial wall as a rare complication of cesarean section, D&C, hysteroscopy, myomectomy, or ovarian puncture. 35 It has been rarely reported on the basis of severe deep infiltrating endometriosis. 36 It is a blood-filled outpouching or diverticula contained within the adventitia or surrounding perivascular soft tissue making it different from a true aneurysm which is less common and contains three-layer arterial wall linings 35 (Figure 2).…”

“…35 It has been rarely reported on the basis of severe deep infiltrating endometriosis. 36 It is a blood-filled outpouching or diverticula contained within the adventitia or surrounding perivascular soft tissue making it different from a true aneurysm which is less common and contains three-layer arterial wall linings 35 (Figure 2). USG shows a cystic structure containing the typical to-and-fro or Ying yang pattern flow on Doppler which is connected to the adjacent parent artery.…”