Uterine arteriovenous malformation
Previous story of caesarean section. Routine exam with no symptoms related.
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The gray-scale sonographic appearances shows a heterogeneous myometrial echotexture due to the presence of multiple serpiginous/tubular anechoic images within the myometrium, at the uterine's fundus, a retroverted uterus.
The colour Doppler demonstrated turbulent flow and showed that the serpiginous/tubular anechoic structures had a low resistance (RI ~0.2-0.5) and a high velocity flow pattern .
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Uterine arteriovenous malformation (AVM) is a rare vascular condition. It is a dilatation of the intervillous space deep inside the myometrium, allowing a direct flow from the arterial system towards the venous system, without participation of capillary vessels. Such condition represents about 1–2% of all genital and intraperitoneal hemorrhages1.
In this case, on a routine exam, the patient had no symptoms related and a previous story of a caesarean section. Unfortunately, we had no past exams to confirm a probably acquired or congenit uterine AVM.
In most cases such malformation is acquired, with a great variety of causes, including gestational trophoblastic disease (GTD), pelvic trauma, surgical procedures (cesarean section, curettage), cervical or endometrial carcinoma, infection and exposure to diethylstilbestrol. The association of the clinical history with imaging findings is useful in the differentiation between congenital and acquired presentations1.
Differential diagnoses with similar sonographic findings include GTD and other hypervascular lesions such as retained conception products and abnormal placentation1.
- 1. Farias MS, Santi CC, Lima AAAA, Teixeira SM, De Biase TCG.Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding. Radiol Bras. 2014 Mar/Abr;47(2):122–124.