P30.13: Sonohysterography is a useful diagnostic approach for uterine arteriovenous malformation

Abstract

Puerperal uterine inversion is a rare obstetric emergency that requires prompt diagnosis and treatment. Since 1985, only nine cases of puerperal uterine inversion have been reported in the literature in which ultrasound aided diagnosis and /or management. We present a case of puerperal uterine inversion which was misdiagnosed as placenta accreta in a remote community hospital.A 28 year old G5T3A2L3 had vaginal delivery at term followed by postpartum hemorrhage due to retained placenta. Manual removal of the placenta was performed after which, an adherent fundal mass was felt suspicious for placenta accreta. Following transfusion and stabilization, patient was evacuated to our institution by air ambulance for further management.On transabdominal pelvic scan, a mirror image appearance of the normally situated uterus was seen on sagittal views along with non-visualization of the cervix. A midline fundal indentation seen extending caudally. A hypoechoic midline echo was noted, resembling an endometrial stripe. Colour Doppler mapping of this area revealed two parallel linear vessels with retrograde caudal blood flow. This appearance was thought to represent an invagination and opposition of the exterior uterine branch vessels, resulting in a vascular, linear ''stripe''. Transverse views of the uterus was consistent with the previously reported Target sign. Provisional diagnosis of complete uterine inversion was made and subsequently confirmed in the operating room and treated appropriately.In conclusion, uterine inversion should be included in the differential diagnosis of postpartum cases with unusual ultrasound appearance of the uterus. Presence of parallel midline vessels along the endometrial pseudostripe with retrograde flow can aid the sonographic diagnosis of complete uterine inversion. P30.13Sonohysterography is a useful diagnostic approach for uterine arteriovenous malformation M. Mishina, J. Hasegawa, M. Nakamura, K. Ichizuka, A. Sekizawa, T. Okai Showa University School of Medicine, Tokyo, JapanUterine arteriovenous malformation (AVM) is a rare cause of abnormal uterine bleeding; nevertheless it is a potentially life-threatening condition when the diagnosis is not made. We report a case of uterine AVM with a secondary uterine hematoma diagnosed two weeks after curettage due to spontaneous abortion. She attended our department complaining persistent uterine bleeding. Urinary human chorionic gonadotropin (hCG) level was 567 IU/l. By transvaginal ultrasound, a 4 × 1.5 cm mixed echogenic mass with no blood flow appeared to exist in the uterine cavity. Additionally, serpiginous expanded blood vessels were seen within the uterine myometrium, close to the mass, depicting multidirectional high-velocity flow by color Doppler examination. Since the location of both structures in the uterus was unclear, sonohysterography was attempted in order to distinguish the endometrium from the myometrium and rule out residual chorionic tissues and clots. This procedure enabled us to recognize clearly the linear endometrium from...