PMC4348402_01
Color flow Doppler ultrasound shows a mosaic pattern of blood flow within cystic spaces in the uterine body.
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Fig1
Color-flow Doppler revealed a mosaic pattern of blood flow within these cystic spaces (Figure 1).
T2-weighted transverse magnetic resonance imaging (MRI) shows multiple tortuous vessels, especially in the anterior uterine wall. Ascites caused by the patient's idiopathic portal hypertension is also present.
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Fig2
Computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple tortuous vessels surrounding the uterus and in the anterior uterine wall (Figure 2).
Computed tomography (CT) angiography suggests multiple expanded vessels around the uterus, including the right uterine artery, right internal iliac artery, right external iliac artery, and left uterine artery.
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Fig3
The patient underwent CT angiography which suggested multiple expanded vessels around the uterus (Figure 3).
Pelvic angiography shows a nidus in the right internal iliac artery.
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Fig4
Pelvic angiography showed that this patient's AVM was supplied by many arteries, including the right uterine artery, right internal iliac artery, right external iliac artery, and left uterine artery (Figure 4).
After embolization of the internal iliac artery using coils and gelatin sponges, there is no significant flow to the AVM.
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Fig5
We performed UAE in the conventional fashion, using coils and gelatin sponges, and found no significant flow to the AVM after the procedure (Figure 5).
Eight days after the first embolization, pelvic angiography shows collateral arteries feeding the uterus from the right external iliac artery.
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Fig6
Eight days after embolization, we repeated pelvic angiography and unfortunately found newly established arteries and collateral vessels feeding the uterus (Figure 6).
Macroscopic examination shows dilated vessels; the arteriovenous malformation rupture site cannot be identified.
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Fig7
The location of the rupture in the AVM could not be identified, either on macroscopic (Figure 7) or microscopic examination (Figure 8).
Microscopic examination shows many dilated thick-walled vessels of varying caliber in the myometrium (hematoxylin-eosin staining; magnification 100x).
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Fig8
The location of the rupture in the AVM could not be identified, either on macroscopic (Figure 7) or microscopic examination (Figure 8).