Uterine artery pseudoaneurysm after dilation and curettage in a woman with multiple hepatic and pulmonary cavernous hemangiomas

Abstract

S. Matsubara).Fig. 1. Uterine artery pseudoaneurysm and multiple hepatic and pulmonary cavernous hemangiomas. (a) Ultrasound findings show that the uterine cavity is occupied by an echogenic mass (star), indicative of hematoma, in which a small anechoic area with flow (short arrows) can be observed. The area marked by a long arrow has pulsatile flow, indicative of arterial flow (right panel). (b) Computed tomography image of the uterus at an early phase after enhancement. The uterine cavity is occupied by hematoma (double arrows), and a small nodular enhancement (arrow) can be seen within it, indicating turbulent flow. (c) Computed tomography image of the liver and the lungs. Multiple masses, some well enhanced, are evident in the liver (black arrow) and the lungs (white arrow). Some masses have calcifications, indicating phleboliths, which are frequently seen in hemangioma. A huge hepatic hemangioma can be seen (star). (d) Selective angiography showing extravasation (short arrows) from the left uterine artery (long arrow).Uterine artery pseudoaneurysm (UAP)-which may occur secondary to tubal surgery [1]-can cause postpartum hemorrhage, especially after cesarean delivery. We report a case of UAP occurring after uneventful dilation and curettage (D&C) in a woman with multiple hepatic and pulmonary cavernous hemangiomas. Informed consent for reporting was obtained from the patient.A 29-year-old nulliparous woman experienced incomplete abortion at 6 weeks. Ultrasound showed a normal-appearing uterus with an empty gestational sac (20-mm diameter). Color Doppler showed no abnormal uterine artery flow or structure. The woman underwent uneventful D&C; 8 days later, massive hemorrhage occurred. Chest X-ray had revealed multiple pulmonary nodules when the patient was 15 years of age. Computed tomography (CT) revealed multiple masses with a progressive centripetal enhancement in both the liver and the lungs: a characteristic finding of cavernous hemangioma. Biopsy confirmed this diagnosis. Computed tomography revealed no hemangiomas in the pelvic cavity.The woman experienced vaginal hemorrhage with mild anemia (hemoglobin 98 g/L) and coagulation disorders (platelets 77 × 10 9 /L; fibrinogen 0.57 g/L; fibrinogen/fibrin degradation product 708 mg/L; D-dimer 132 mg/L). Ultrasound revealed that the uterine cavity was occupied by an echogenic mass with a small anechoic area with turbulent flow (Fig. 1a); CT revealed an intrauterine mass with no enhancement and a mass with a small nodular enhancement (Fig. 1b), in addition to multiple hemangiomas in the lungs and the liver (Fig. 1c). The presence of hemangiomas and coagulation disorders indicated Kasabach-Merritt syndrome. Pelvic angiography showed extravasation from the left 84 BRIEF COMMUNICATIONS

Recurrent uterine artery pseudoaneurysm

“…We previously showed that some underlying vascular disorders (cavernous hemangioma) may contribute to UAP formation. 3 At present, there is no evidence indicating any underlying vascular disorders in this patient. We must cautiously follow her, as some vascular disease may become evident later.…”

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

“…Pseudoaneurysm can arise from various arteries and is an undesirable complication after treatment of various organs and disorders. Although the cause has not been elucidated, or such characteristics as whether it occurs only in certain persons or in persons who originally have a vascular lesion (12), and how often it disappears spontaneously, it is believed to commonly occur during surgical vascular injury and its healing process. Regarding the etiology of RAP after PN, Singh and Gill proposed two mechanisms: (I) inadvertent vascular injury during tumor resection, and (II) vascular injury during parenchymal renorrhaphy (13).…”

“…nephrometry score, median[IQR, range] 7[3,[4][5][6][7][8][9][10] R.E.N.A.L. nephrometry score, low[4][5][6]/moderate[7][8][9]/high[10][11][12]IQR, interquartile range; BMI, body mass index; ASA-PS, American Society of Anesthesiologists physical status; eGFR, estimated glomerular filtration rate; R.E.N.A.L., radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line; RCC, renal cell carcinoma.Transl Androl Urol 2021 | https://dx.doi.org/10.21037/tau-21-384 © Translational Andrology and Urology. All rights reserved.…”

Multiple cavernous hemangiomas of the lung and liver mimicking metastasis

“…[3] Some literature reported cavernous hemangiomas not only occurring in the lung, but also appearing in other organs of the body, such as the liver and pericardium. [2,4,5] Severe bleeding caused by rupture of HCHs has been reported which leads to death. [3] Therefore, it is important to identify reliable methods for the differential diagnosis of PCHs.…”