PMC3173835_01
(a) Gray-scale ultrasound of the pelvis shows a hypoechoic lesion in the anterior wall of uterus. (b) Power Doppler evaluation of the uterus demonstrates blood flow within this hypoechoic lesion.
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F1
A hypoechoic lesion measuring 2 cm x 1.5 cm [Figure 1a] was detected in the isthmic region of uterus and power Doppler revealed blood flow within it [Figure 1b].
(a) Axial and (b) Sagittal MPR CT Angiogram images show contrast filling the pseudoaneurysm (arrow) within the uterus. (c) MIP and (d) VR images show a pseudoaneurysm in relation to the left uterine artery.
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F2
Computed tomography angiogram was done with non-ionic contrast showed early contrast filling of the lesion within the uterus [Figure 2a, b]. Maximum intensity projection (MIP) and Volume rendered (VR) images nicely demonstrated the pseudoaneurysm in relation to the uterine artery [Figure 2c, d].
Selective left internal iliac angiogram: (a) Early and (b) late phase shows the pseudoaneurysm (arrows), arising from the left uterine artery (arrowhead) in addition the hypertrophy of the left uterine artery can also be appreciated.
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F3
Arteriography revealed a pseudoaneurysm from the terminal part of the left uterine artery, in addition the left uterine artery was tortuous and was hypertrophied [Figure 3a, b].
(a) Embolization coils (arrow) within the pseudoaneurysm. (b) Selective left internal iliac angiogram (Postembolization) using gelfoam and embolization coils show complete obliteration of the pseudoaneurysm. (c) Follow up color Doppler sonography shows no evidence of blood flow within the pseudoaneurysm.
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F4
Left uterine artery was selectively embolized with mixture of gelfoam and contrast media followed by 2 stainless steel coils 4 mm in diameter [Figure 4a]. A post embolization angiographic study was performed to ensure the complete occlusion of the vessels [Figure 4b]. Follow-up color Doppler US showed aneurysmal cavity filled with echogenic content with no evidence of blood flow [Figure 4c], except for pain in the abdomen that was managed with analgesics.