Uterine Arteriovenous Malformation with Sudden Heavy Vaginal Hemmorhage

Abstract

Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential. Most presentations of DUB are in hemodynamically stable patients and can be evaluated as an outpatient. Uterine arteriovenous malformation (AVM) is one presentation that can result in a life-threatening medical emergency with unexpected sudden and massive vaginal bleeding. We describe a case of a 24-year-old female with sudden heavy vaginal bleeding requiring a blood transfusion, ultrasound evidence of uterine AVM, and a treatment method of expectant management using an intrauterine device in an attempt to preserve fertility.

A Case of Congenital Uterine Arterio-Venous Malformation Managed by Hysterectomy

“…These may be either congenital or acquired. Congenital malformations are a result of abnormal embryologic angiogenesis leading to the formation of multiple abnormal connections between arteries and veins [ 4 ]; acquired AVMs (also known as traumatic AVMs) are formed due to multiple small fistulae between arteries and veins and occur as a result of previous uterine instrumentation, gestational trophoblastic disease, choriocarcinoma, endometrial carcinoma, cervical cancer, infection or uterine surgery and trauma [ 3 , 5 ]. Imaging features in both forms are similar and patient history is helpful in distinguishing the two.…”

A rare case of arteriovenous malformation following hysterectomy in a case of choriocarcinoma

“…Congenital malformations are a result of abnormal embryologic angiogenesis leading to the formation of multiple abnormal connections between arteries and veins. 3 Acquired AVMs (also known as traumatic AVMs) are formed due to multiple small fistulae between arteries and veins and occur as a result of previous uterine instrumentation, gestational trophoblastic disease, choriocarcinoma, endometrial carcinoma, cervical cancer, infection or uterine surgery and trauma. 4,5 Imaging features in both forms are similar and patient history is helpful in distinguishing the two.…”

Heavy vaginal bleeding, post termination of pregnancy: not always retained products of conception

“…In Gray scale ultrasound, uterine AVMs are seen as subtle myometrial heterogeneity, tubular sparse multiple spaces in the myometrium and color doppler and spectral studies demonstrate flow reversals and 'colour mosaic 'pattern. 1,6 Gray scale ultrasound by itself is nonspecific however addition of colour doppler and spectral studies increase accuracy of ultrasound imaging. Other imaging modalities used are MRI and CT, with angiography being considered as a gold standard.…”

“…The exact incidence of uterine AVM is not known but fewer than 100 cases have been reported in the literature. [1][2][3] The usual presentation to the emergency department of a uterine AVM is heavy vaginal bleeding, usually with a background of intrauterine instrumentation like curettage or caesarean section. Historically, uterine AVMS were diagnosed in hysterectomy specimens but with advent of improved imaging facilities, it has been possible to diagnose the AVMs in a much more timely manner rather than just in hysterectomy specimens.…”