Presentation
Vaginal bleeding.
Patient Data
Post-contrast abdominal CT scan reveals a high flow pelvic AVM fed mainly by a prominent inferior mesenteric artery and drained by a very large tortuous vein (inferior mesenteric vein) that ended in the confluence of the splenic and the superior mesenteric vein. Uterine, vaginal, and rectal involvement is seen.
Intrathecal shunt for relieving intracranial hypertension seen in the thoracolumbar region ended subcutaneously in the right side of the anterior abdominal wall.
Re-evaluation CT scan after a trial of intravascular embolization shows minimal changes of the AVM with hepatic seeding of the occlusive material
Case Discussion
Early venous enhancement and a markedly dilated draining vein go with long-standing high flow arteriovenous malformations. Although the involvement of the anterior rectal wall is more obvious than the uterine involvement on CT; vaginal bleeding was the main complaint of this patient.