A rare case of arteriovenous malformation following hysterectomy in a case of choriocarcinoma

Authors

  • Suchitra R Department of Gyneac-oncology, Mazumdar Cancer Centre, Narayana Health, Bangalore, Karnataka, India
  • Manjunath P Department of Vascular and Interventional Radiology, Mazumdar Cancer Centre, Narayana Health, Bangalore, Karnataka, India
  • Shameem Taj Department of Gyneac-oncology, Mazumdar Cancer Centre, Narayana Health, Bangalore, Karnataka, India
  • Radhika Kalla Department of Gyneac-oncology, Mazumdar Cancer Centre, Narayana Health, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20150746

Keywords:

AVM, Choriocarcinoma, CT angiogram, Embolisation

Abstract

A uterine arteriovenous malformation (AVM) is a rare cause of uterine bleeding. It may have varied presentations ranging from being completely asymptomatic; to features of congestive heart failure, to vaginal bleeding which may at times life be threatening. Clinical findings in such cases are often un-reliable; requiring a high index of suspicion to make the diagnosis. We report a case of a 46-year-old lady who presented with heavy vaginal bleeding. She has undergone hysterectomy with a histopathology of choriocarcinoma one and half months back. She has received chemotherapy and 8 fractions of radiotherapy for the same. AVM was diagnosed following a CT angiogram and was managed by embolization. We also discuss in brief about this uncommon but serious condition which the radiologist/gynaecologist may encounter in their practice. AV Malformation is a rare but potentially life-threatening cause of vaginal bleeding which must be kept in the differential diagnosis of sudden and massive vaginal bleeding. It requires a high index of clinical suspicion. Despite its rarity, early recognition of an AVM is imperative to enable timely diagnosis and intervention.

References

Dubreuil G, Loubat E. Aneurysme crisoide de l? Uterus Ann Anat Pathol. 1926;3:697-718.

O’Brien P, Neyastani A, Buckley AR, Chang SD, Legiehn GM. Uterine arteriovenous malformations: from diagnosis to treatment. J Ultrasound Med. 2006;25:1387-92.

Selby ST, Haughey M. Uterine arteriovenous malformation with sudden heavy vaginal hemmorhage. West J Emerg Med. 2013;14:411-14.

Hoffman MK, Meilstrup JW, Shackelford DP, Kaminski PF. Arteriovenous malformations of the uterus: an uncommon cause of vaginal bleeding. Obstet Gynecol Surv. 1997;52:736-40.

Fleming H, Ostör AG, Pickel H, Fortune DW. Arteriovenous malformations of the uterus. Obstet Gynecol. 1989;73:209-14.

Goldrath MH. Uterine tamponade for the control of acute uterine bleeding. Am J Obstet Gynecol. 1983;147:869-72.

Gary P. Siskin. Application of pelvic embolization beyond uterine fibroids in interventional radiology in women’s health. Thieme. 2011 Jan;8:85-90.

Flynn MK, Levine D. The noninvasive diagnosis and management of a uterine arteriovenous malformation. Obstet Gynecol. 1996;88(4 Pt 2):650-2.

Cura M, Martinez N, Cura A, Dalsaso TJ, Elmerhi F. Arteriovenous malformations of the uterus. Acta Radiol. 2009;50:823-9.

Timmerman D, Van den Bosch T, Peeraer K, Debrouwere E, Van Schoubroeck D, Stockx L, et al. Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management. Eur J Obstet Gynecol Reprod Biol. 2000;92:171-8.

O’Brien P, Neyastani A, Buckley AR, Chang SD, Legiehn GM. Uterine arteriovenous malformations: from diagnosis to treatment. J Ultrasound Med. 2006;25:1387-92.

Brown JV 3rd, Asrat T, Epstein HD, Oglevie S, Goldstein BH. Contemporary diagnosis and management of a uterine arteriovenous malformation. Obstet Gynecol. 2008;112(2 Pt 2):467-70.

Fleming H, Ostor AQ, Pickel H, Forune DW. Artiovenous malformations of the ulerus. Obstet Gyneccol. 1989;73(2):209-14.

Downloads

Published

2017-02-10