Uterine artery pseudoaneurysm

Case contributed by Dr Aliakbar Sahraei

Presentation

G3P3 underwent cesarian section (CS) at 40 weeks' gestation due to previous CS. Admitted to the emergency department due to abnormal uterine bleeding (manifesting as menstrual bleeding) 10 days after CS.

Patient Data

Age: 30 years
Gender: Female

Transvaginal

Ultrasound

Longitudinal gray-scale US image shows a cystic lesion in the uterus. Color Doppler US image shows that the sac is filled with blood. Longitudinal duplex Doppler US image shows the to-and-fro pattern flow within the pseudoaneurysm. 

Uterine artery

DSA (angiography)

Right internal iliac angiogram shows the pseudoaneurysm, which is supplied by the right uterine artery.

Case Discussion

Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum hemorrhage.

 In this case, transvaginal color Doppler US showed a 12 mm cystic structure in right wall of uterus with varying colors and yin-yang appearance. Duplex Doppler US showed turbulent flow within the structure, Doppler US scan identified to-and-fro flow in the sac, indicating a pseudoaneurysm.

Bilateral angiogram confirmed pseudoaneurysm in the right uterine artery.

Angiography and embolization performed by Dr Mohammad Momen Gharibvand, interventional radiologist at Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

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