Uterine arteriovenous malformation

Case contributed by Rubens Ribeiro de Souza


Previous story of cesarean section. Routine exam with no symptoms related.

Patient Data

Age: 30 years
Gender: Female

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 color 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.

Case Discussion

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 cesarean section. Unfortunately, we had no past exams to confirm a probably acquired or congenital 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.

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