30 years second para had menorrhagia for 2 months after D & E. USG and pelvic angiogram were suggestive of uterine AVM on left side (Figs. 1, 2, 3). Patient gave negative consent for uterine artery embolisation. She started bleeding torrentially leading to hypotension. Hence balloon tamponade was done that kept the bleeding under control for 12 days till hysterectomy was done after the couple insisted for hysterectomy. Gross specimen and HPR proved the diagnosis (Figs. 4, 5).
Fig. 1.
CT Pelvic Angiogram: showing multiple, tiny linear serpigeneous flow void structures in myometrium predominantly in left posterolateral aspect with mild sub-mucous projections suggesting AV malformation of uterine myometrium with feeding vessels arising from bilateral internal iliac arteries
Fig. 2.
USG Doppler: normal sized uterus with endometrial thickness of 8 mm; significantly raised vascularity seen in myometrial - endometrial junction and focally in endometrium. Findings were suggestive of arterio-venous malformation (AVM) of uterus in lower segment
Fig. 3.
USG-Gray scale: showing multiple tubular or ‘spongy’ anechoic or hyperechoic areas within the myometrium
Fig. 4.
Gross specimen of the uterus
Fig. 5.
Histopathology: showing dilated & ecstatic vessels with anastomosing arteries & veins; dilated, ecstatic & thrombosed vessels throughout the myometrium. No evidence of any malignancy in the sections studied
Dr. Sandhya Gadre,
professor in Obstetrics and Gynaecology at Chirayu Medical College and Hospital, Bhopal. She is a fellow of ICOG. Reviewer for JOGI, JEMDS. She has reviewed many MD dissertations and research articles. She has nine research publications as a first author. She has been invited as a guest speaker, panelist at AICOG and also at AMPOGS several times. She has presented many oral papers and posters at AICOG and AMPOGS. She is a resource faculty for medical education. She has been office bearer several times at local FOGSI. She is always enthusiastically interested in implementing her own innovative ideas in teaching the students.
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
As per the protocol of the journal a written informed consent was obtained from the concerned patient that her case details & clinical photographs will be sent for publication in a scientific journal. She has consented for that in writing.
Footnotes
Sandhya Gadre, Professor, Department of Obstetrics and Gynaecology, Chirayu Medical College & Hospital, Bhopal; Sushruta Shrivastava, Assistant Professor, Department of Obstetrics and Gynaecology, Chirayu Medical College & Hospital, Bhopal; Purva Tripathi, Senior Resident, Department of Radiodiagnosis, Chirayu Medical College & Hospital, Bhopal; Manal A. Ali, Assistant Professor, Department of Pathology, Chirayu Medical College & Hospital, Bhopal.