Presentation
Persistent metrorrhagia following dilation and curettage for miscarriage 2 months ago.
Patient Data
There is an intramyometrial echogenic area, containing numerous anechoic tubular structures. The color Doppler demonstrates markedly increased flow within the tubular structures.
There are multiple prominent intramyometrial serpentine vascular structures mainly of left fundal/corporeal location as well as in the endometrial cavity. They appear as signal voids structures on all sequences with early intense enhancement on the dynamic sequence.
Case Discussion
The clinical history, Doppler ultrasound and MRI features are most consistent of an acquired uterine arteriovenous malformation.
The diagnosis of a uterine arteriovenous malformation should be considered in a young patient with massive prolonged bleeding, especially if there is a history of dilation/curettage, cesarean section or termination of pregnancy.
On imaging differential diagnoses should include:
The best treatment is the arterial embolization of the malformation.