PMC4161720_01
Transvaginal ultrasonography and pelvic contrast-enhanced computed tomography on the day of delivery. (A) pseudoaneurysm (black arrows) and adjacent hematoma (white arrows) in B-mode (B) pseudoaneurysm in power-Doppler mode. (C) hematoma (white arrow) on computed tomography (D) pseudoaneurysm (white arrows) on the next caudal slice of the hematoma.
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Fig1
When all sutures were released, pulsatile bleeding was confirmed, necessitating a second repair.Two hours after the second repair, transvaginal ultrasonography showed a hyperechoic 18 x 20 mm mass at the 5 o'clock position on the vaginal wall, suggestive of a hematoma, within which a 6 x 7 mm anechoic mass with pulsation was described (Figure  1A). Power-Doppler ultrasonography showed blood flow signals in the anechoic mass (Figure  1B), and arterial waveforms were detected in pulsed-Doppler mode. Contrast-enhanced CT revealed an 8 mm diameter pooling of contrast adjacent to an 18 x 32 mm mass in the pelvis (Figure  1C, D).
Pelvic contrast-enhanced computed tomography pseudoaneurysms (white arrows). (A) on the fourth postpartum day (B) on the sixth postpartum day.
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Fig2
By the fourth postpartum day, the pseudoaneurysm had grown to 10 mm in diameter (Figure  2A). Contrast-enhanced CT showed that the pseudoaneurysm had grown to 14 mm (Figure  2B).
Pelvic angiography on the sixth postpartum day showed strong staining (white arrows) with extravasation (black arrows) indicating ruptured pseudoaneurysm arising from the left vaginal artery (open arrow).
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Fig3
Emergency selective angiography showed strong staining with extravasation from a peripheral branching vessel of the left vaginal artery, indicating ruptured pseudoaneurysm (Figure  3).