case_images: PMC4161720_01
case_images: 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.
case_images: 40064_2014_1190_Fig1_HTML.jpg
case_images: PMC4161720_01_40064_2014_1190_Fig1_HTML.jpg
case_images: Fig1
case_images: 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).
case_images: Pelvic contrast-enhanced computed tomography pseudoaneurysms (white arrows). (A) on the fourth postpartum day (B) on the sixth postpartum day.
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case_images: PMC4161720_01_40064_2014_1190_Fig2_HTML.jpg
case_images: Fig2
case_images: 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).
case_images: 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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case_images: PMC4161720_01_40064_2014_1190_Fig3_HTML.jpg
case_images: Fig3
case_images: Emergency selective angiography showed strong staining with extravasation from a peripheral branching vessel of the left vaginal artery, indicating ruptured pseudoaneurysm (Figure  3).