PMC6195931_01
(a) Axial image from the CT angiogram of the pelvis demonstrates right uterine artery pseudoaneurysm indicated by the focal abnormal dilatation of the artery (long arrow in the enlarged inset image) compared with the normal calibre left uterine artery (short arrow). (b) Delayed venous phase axial image of the pelvis demonstrating enhancing enlarged postpartum uterus and high-density fluid in the pelvis (curved arrow). (c) Haemoperitoneum within the abdomen.
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fig1
This revealed a focal dilatation of the ascending segment of the right uterine artery measuring 6 mm, suggestive of a pseudoaneurysm and extensive haemoperitoneum within the abdomen and pelvis (Figures 1 and 2).
Coronal maximum intensity projection reconstructed images of the CT angiogram clearly demonstrates the pseudoaneurysm of the ascending portion of the right uterine artery (short arrow) compared with normal appearance of the left uterine artery (curved arrow). Long arrow indicates free fluid in the abdomen on the right side.
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fig2
This revealed a focal dilatation of the ascending segment of the right uterine artery measuring 6 mm, suggestive of a pseudoaneurysm and extensive haemoperitoneum within the abdomen and pelvis (Figures 1 and 2).
(a, b) Conventional pelvic angiogram images obtained by contrast injection via catheters placed in the right common iliac and right internal iliac artery, respectively. Both demonstrate the right uterine artery pseudoaneurysm (arrows) as seen on the CT angiogram images (Figure 2). Also shown is increased vascularity of the postpartum uterus.
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fig3
A right uterine artery pseudoaneurysm was demonstrated on the right iliac angiogram (Figure 3) corresponding to the CT angiogram findings with no active bleeding.
Selective angiogram of the right uterine artery with the catheter tip in the proximal right uterine artery clearly shows the pseudoaneurysm with active contrast extravasation (arrow) indicative of active bleed.
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A selective right uterine artery angiogram demonstrated active contrast extravasation, which was probably owing to the disruption of the clot surrounding the pseudoaneurysm due to the pressure from the contrast injection directly into the mid-uterine artery as opposed to the non-selective earlier angiograms (Figure 4).
Selective angiogram of the right uterine artery after coil (arrow) embolization of the mid portion of the vessel shows no filling of the previously seen pseudoaneurysm or active bleed.
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fig5
The final angiogram showed no evidence of the previously demonstrated pseudoaneurysm or bleeding and stasis of flow in the right uterine artery (Figure 5).