Uterine arteriovenous fistula: A case report and literature review

Uterine arteriovenous fistula (UAVF) is not very common and can occur after traumatic activities, such as surgery, delivery, miscarriage, and curettage. Previous studies have reported on the ultrasound and digital subtraction angiography (DSA) findings of UAVF; however, there are few reports on computed tomography (CT), CT angiography (CTA), and magnetic resonance imaging (MRI) findings. We report a case in which residual products of conception were diagnosed during an MRI, with an oversight of the presence of UAVF.

A female aged 34 years presented with intermittent vaginal bleeding for 15 days that had increased in the last 2 hours, 43 days after an abortion. Ultrasound showed abnormal echo masses in the right uterine horn. MRI examination showed incomplete pregnancy. CT, CTA, and DSA examinations showed incomplete pregnancy with UAVF.

The postoperative combined pathological diagnosis was right uterine horn insufficiency abortion with UAVF.

To reduce intraoperative bleeding, interventional embolization was performed, followed by surgical resection.

Recovery was good, and the patient was discharged.

After an induced abortion, especially after multiple abortions, in patients presenting with abdominal pain, irregular vaginal bleeding, sudden heavy bleeding, and other phenomena, we should consider the possibility of UAVF. In this paper, we report using CT, CTA, MRI, and DSA imaging findings of UAVF to improve our understanding of UAVF imaging performance. For patients with persistent bleeding and fertility requirements that require immediate surgical resection of the lesion, interventional embolization and resection of the lesion can be selected to reduce the risk of intraoperative bleeding and recurrence.