Pyomyoma after Uterine Artery Embolization

Pyomyoma Following Uterine Artery Embolization (UAE) – Dual Case Report and Review of Literature

“…Those with hypertension, hyperlipidemia, diabetes, post-partum, immunocompromised and those with a large dominant leiomyoma are at increased risk for the development of pyomyoma [10,14,19]. Though rare, pyomyoma has had other documented links to UAE besides the cases that we presented [4,8,9]. Other documented links to pyomyoma include intravenous drug abusers [20], presence of intra uterine devices [1], and hypertension especially when combined with hyperlipidemia [21].…”

“…A major finding in our reports is that both patients developed pyomyoma post uterine artery embolization however prior reports of pyomyoma associated with uterine artery embolization is rare [4,10]. Absolute contraindications to UAE include viable pregnancy, coagulopathy and active infection due to risk of abscess formation [8]. Relative contraindications to pelvic embolization include immunocompromised states (such as diabetes and HIV), prior pelvic irradiation or surgery, and chronic endometritis or a partially treated pelvic infection [14].…”

“…Postembolization syndrome (PES) consists of abdominal pain, nausea, vomiting and fever that usually subsides after the first few days of onset. The presence of intrauterine infection and exclusion of PES can be determined on the basis of one or more of the following: presence of foul-smelling vaginal discharge, presence of high-grade leukocytosis, clinical course of the initial symptoms (PES occurs within a few days of UAE), and clinical improvement with therapy [7,8]. The manifestation of pyomyoma can be subtle, developing within days or weeks after a procedure, as in the cases that we presented.…”

“…Relative contraindications to pelvic embolization include immunocompromised states (such as diabetes and HIV), prior pelvic irradiation or surgery, and chronic endometritis or a partially treated pelvic infection [14]. Prior to considering a patient for UAE, assessment of risk factors and comorbidities is essential [8]. All of these conditions predispose women to a higher risk of an infectious complication [14].…”

“…A very rare but serious complication known to exist following UAE is that of pyomyoma, a suppurative leiomyoma of the uterus [3,4,[8][9][10]. Pyomyoma (suppurative leiomyoma) results from infarction, necrosis, and infection of the leiomyoma [1,[3][4][5][11][12][13][14][15][16].…”