EP20.23: Arteriovenous uterine malformation a new challenge: ultrasound contribution – two case reports

Abstract

Uterine arteriovenous malformations (AVMs) are uncommon anomalies that can be congenital or acquired, with the latter often related to pregnancy-associated iatrogenic uterine trauma. Transvaginal Doppler ultrasonography serves as a readily available, non-invasive, and effective diagnostic tool. This paper presents two cases of AVMs in patients aged 25 and 37, with obstetric histories of P0G2M2 and P2G4M2 respectively. Both experienced recurrent significant vaginal bleeding following miscarriage. The first patient's pelvic ultrasound revealed a 2*4 cm, echogenic, vascular structure posterior to the endometrial complex, with a peak systolic velocity (PSV) of 75.9 cm/s, indicative of uterine AVMs, later confirmed by computerised tomography angiography (CTA). For the second patient, ultrasound coupled with Doppler showed an intracavitary hypoechoic image, measuring 20*24 mm, hypervascularised on colour Doppler, with a PSV of 41 cm/sec. Both patients were admitted; the first underwent uterine artery embolization followed by operative hysteroscopy, while the second underwent laparoscopic bilateral ligation of the hypogastric arteries due to financial constraints, followed by operative hysteroscopy. Symptoms resolved during follow-up, with repeated ultrasound confirming resolution of the AVMs. AVMs may be mistaken for gestational-related issues, vascular abnormalities, or uterine malignancies. Hence, clinical examination and diagnostic imaging, particularly quantitative ultrasound blood flow measurements, are vital for accurate diagnosis and differentiation from other conditions. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.