PMC4835739_01
A 25-year-old female with a history of dysmenorrhea and irregular duration and intervals of menstrual cycles who came to the emergency department with acute abdominal pain and heavy vaginal bleeding with blood clots. A, Transvaginal gray-scale ultrasonography of the uterus revealed multiple varying-sized hypo-echoic lesions. B, At the same plane, the color Doppler ultrasonography showed a hypervascular lesion with multidirectional turbulent flow (typical mosaic pattern), measuring 4.9 x 3.3 x 2.6 cm in size in the endometrium and myometrium of the uterine fundus. C, During angiography, the catheter was inserted from the right femoral artery and its tip was at the end of the abdominal aorta. Aortography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with rapid venous shunting. D, After right-uterine-artery embolization, there were still some collateral abnormal vessels formed on the left side. E, Finally, bilateral superselective embolization of the uterine arteries was done smoothly.
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The gray-scale ultrasonography revealed multiple varying-sized hypo-echoic lesions (Figure 1A). The color Doppler ultrasonography showed a hypervascular lesion, 4.9 x 3.3 x 2.6 cm with multidirectional turbulent flow (Figure 1B). TAE. The angiography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with relatively early venous return (Figure 1C), which indicated the diagnosis of uterine AVM. On checking the left uterine artery, the angiography showed that there were still a few abnormal collateral vessels (Figure 1D). Therefore, bilateral uterine artery embolization was performed (Figure 1E).
PMC4835739_02
A 38-year-old female with hypermenorrhea and intermittent severe abdominal pain for 12 days. A, Transvaginal gray-scale ultrasonography of the uterus shows hypo-echoic cyst-like lesions. B, The color Doppler ultrasonography demonstrates a hypervascular lesion, 2.7 x 2.4 x 2.1 cm with multidirectional turbulent flow at the body of the uterus. The main lesion is in the myometrium. C, Spectral Doppler ultrasonography shows low resistance index of 0.4. D, Angiography shows vascular tangles from the branches of the bilateral internal iliac arteries. E, Bilateral superselective embolization of the uterine arteries was done smoothly. F, The follow-up color Doppler ultrasonography shows a smaller lesion, 2.0 x 1.3 cm with minimal vascularity.
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The gray-scale ultrasonography revealed hypo-echoic cyst-like lesions (Figure 2A). The color and spectral Doppler ultrasonography demonstrated a hypervascular lesion in the body of the uterus, 2.7 x 2.4 x 2.1 cm with multidirectional turbulent flow, and the resistive index (RI) was 0.4 (Figure 2B and C). The angiography clearly showed the vascular tangles from the branches of the bilateral internal iliac arteries (Figure 2D). TAE was performed with two microcatheters placed in the bilateral uterine arteries. We injected NBCA slowly till stasis, and the vessels revealed occlusion (Figure 2E). TAE, confirmed great improvement (Figure 2F). Thirty eight days later, she started normal menstrual periods.
PMC4835739_03
A 22-year-old female with prolonged menstrual bleeding for 2 weeks and sudden heavy vaginal bleeding. A, Gray-scale ultrasonography reveals multiple hypo-echoic myometrial lesions. B, Color Doppler ultrasonography shows a hypervascular lesion, 3.0 x 2.7 x 1.7 cm in the endometrium and myometrium of the uterine fundus. C and D, Angiography of the right and left uterine arteries demonstrates multiple abnormal vessels from the bilateral uterine arteries, particularly from the right side, and rapid venous shunting. E and F, After treatment, angiography shows total occlusion of AVM.
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Gray-scale ultrasonography revealed multiple hypo-echoic myometrial lesions (Figure 3A). Color and spectral Doppler ultrasonography showed a hypervascular lesion, 3.0 x 2.7 x 1.7 cm with multidirectional turbulent flow (Figure 3B), and RI was 0.3. Angiography showed multiple abnormal vessels from the bilateral uterine arteries, particularly from the right side, and rapid venous shunting (Figure 3C and D). TAE was performed using NBCA to obstruct the bilateral uterine arteries (Figure 3E and F).