Uterine Arteriovenous Malformation—An Important Differential in Abnormal Uterine Bleeding and Its Successful Management with Uterine Artery Embolization: A Case Report

Aim and background: Uterine arteriovenous malformations (AVMs) are a rare entity.However, they are a serious cause for abnormal uterine bleeding (AUB) in women of reproductive age.They should be suspected in women presenting with heavy bleeding post dilation and curettage (D&C).This case report highlights one such case and its successful management.Case description: A 34-year-old multiparous female with a history of one prior normal vaginal delivery and one spontaneous abortion presented with complaints of heavy menstrual bleeding persisting for 4 months.Clinical examination showed a stable hemodynamic status.Pelvic examination was unremarkable, and no palpable uterine or cervical masses were identified.Transvaginal ultrasound showed a bulky uterus with a hypervascular lesion near the uterine fundus with turbulent blood flow, suggesting a possible arteriovenous malformation.The endometrial thickness was 6 mm, with no retained products of conception (RPOC).Magnetic resonance imaging (MRI) of the abdomen and pelvis showed a bulky uterus with a focal vascular malformation measuring 21 mm in the outer myometrium of the uterine fundus, with early venous drainage from hypertrophied uterine arteries.Given the diagnosis of uterine AVM, uterine artery embolization (UAE) was recommended to control the bleeding and preserve fertility.The patient underwent UAE under fluoroscopic guidance.Postembolization angiography demonstrated no residual blood flow to the malformation.The procedure was well tolerated, and the patient was discharged 24 hours postintervention with no immediate complications.The patient recovered well following the procedure. Conclusion:We have to suspect AV malformation as a cause of AUB in women of reproductive age, especially with a history of D&C.Ultrasound is a good modality to diagnose AVM early, while MRI is the gold standard for diagnosis.Uterine artery embolization is thus a minimally invasive and effective treatment for uterine AVM.Clinical significance: Uterine AVMs are a rare but serious cause of AUB, often arising from trauma to the uterus.Early diagnosis using noninvasive imaging techniques, such as Doppler ultrasound and MRI, is crucial in identifying uterine AVMs, especially in patients presenting with abnormal bleeding after uterine surgeries.Uterine artery embolization is an effective, minimally invasive treatment that preserves fertility and avoids the risks associated with more invasive surgical interventions such as hysterectomy.