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Microspheres vaginal discharge as a complication after Uterine Artery Embolization for intramural/submucosal fibroid
Cecilia Gozzo1, Giovanni Failla1, Andrea Musumeci1
1Department of Medical Surgical Sciences and Advanced Technologies, Radiology I unit, University of Catania, Via Santa Sofia 78, Catania 92123, Italy.
Abstract:
Among Uterine Artery Embolization (UAE) complications, vaginal discharge is considered very frequent, especially for submucosal fibroids. Until now, it was reported as clear odorless viscous material. To our knowledge, we describe the first report of intrauterine microsphere migration after UAE. A 45-year-old-woman was admitted to our hospital complaining metromenorrhagia, menstrual cramping, pelvic pain and dyspareunia. After a preprocedural Magnetic Resonance Imaging (MRI) study, she underwent a superselective transradial UAE using 500-700 µm and 700-900 µm microspheres with a good morphological results. At 2-month follow-up, she complained viscous vaginal discharge with "strange pink stiff sphere of about 2 mm in diameter". A post-procedural-MRI showed fibroid migration towards the uterine cavity, a frequent occurrence especially for submucosal fibroids. The microspheres transvascular migration outside the vessel wall was already reported in a study performed in sheep. Our hypothesis is that the phenomenon of transvascular migration along with the fibroid migration towards the uterine cavity after UAE, may have led the migration of the microspheres directly into the vaginal cavity causing chronic vaginal discharge with pink stiff sphere. Vaginal discharge mixed with "sphere of particles" should be included among the UAE late complication especially for intramural and/or submucosal fibroids with distance to the endometrium less than 2.4 mm at pre-procedural MRI.
Insights
Vaginal discharge with unusual spheres after Uterine Artery Embolization (UAE) may indicate microsphere migration. This rare complication is linked to fibroid migration, particularly with submucosal fibroids.
Area of Science:
- Interventional Radiology
- Gynecology
- Vascular Surgery
Background:
- Uterine Artery Embolization (UAE) is a common procedure for treating uterine fibroids.
- Vaginal discharge is a known complication of UAE, typically presenting as clear, odorless, viscous material.
- Submucosal fibroids are particularly associated with post-UAE vaginal discharge.
Observation:
- A 45-year-old woman presented with symptoms including metromenorrhagia, cramping, pelvic pain, and dyspareunia.
- Following UAE with 500-700 µm and 700-900 µm microspheres, the patient reported viscous vaginal discharge containing "strange pink stiff spheres."
- Post-procedural MRI revealed fibroid migration towards the uterine cavity.
Findings:
- This case represents the first reported instance of intrauterine microsphere migration following UAE.
- The microspheres were hypothesized to have migrated transvascularly and subsequently into the vaginal cavity, associated with fibroid migration.
- The presence of "sphere of particles" in vaginal discharge is proposed as a new late complication of UAE.
Implications:
- Vaginal discharge containing particulate matter should be considered a potential late complication of UAE.
- This complication may be more prevalent in cases involving intramural or submucosal fibroids with close proximity to the endometrium (<2.4 mm).
- Further investigation into the mechanisms of microsphere migration in UAE is warranted.
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