Presentation
Irregular menstrual cycles and anemia since menarche.
Patient Data
Enlarged uterus with complete myometrial inhomogeneity. There are multiple tubular anechoic spaces of varying sizes within the myometrium, giving an aspect of a uterine mass.
Doppler color showed increased vascularity with multiple prominent and disorganized vascular components. Spectral mode shows a high-velocity flow pattern and low vascular resistance (RI 0.3).
Both annexes with increased echogenicity of the medulla and multiple follicles in the ovarian periphery.
Case Discussion
Uterine arteriovenous malformations (AVMs) are a rare group of vascular anomalies that can be acquired (most common) or congenital. Congenital AVMs are a consequence of abnormal vascular differentiation in the capillary network.
This was a case of an 18-year-old nulliparous female with menarche at 13 years old and a history of abundant vaginal bleeding/anemia. An endovaginal pelvic ultrasound demonstrated a mass-like lesion within the myometrium that contained multiple disorganized vascular tracts with high flow velocity and low resistance.
MRI is another modality of image for diagnosis, showing multiple serpentine flow-related signal voids in the myometrium, endometrial cavity, parametrial, or cervical region on T1 and T2-weighted images. Using contrast-enhanced dynamic sequences could help.
Angiography (DSA) is another diagnosis/therapeutic choice. This modality can depict a vascular lesion within the myometrium with early venous filling. In selected patients, treatment with arterial embolization could be considered.
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