case_images: PMC11809768_01
case_images: MRI of the pelvis with contrast showing the uterus is retroverted measuring 8.5 x 8 x 4 cm. Intrauterine intracavitary mass-like lesion measures 3 x 2.7 x 2.5 cm, collectively formed of multiple serpentine flow-related signal voids. It extends from the right parametrium through the anterior uterine wall mid-corporal to the endometrial cavity extending further to the left parametrium. A post-contrast examination shows the abnormal complex enhancement of serpentine vessels. Findings are suggestive of uterine arteriovenous malformation.
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case_images: FIG1
case_images: MRI of the pelvis with which showed findings suggestive of UAVM (Figure 1).
case_images: Uterus is normal in size with abnormal myometrium having multiple feeding arteries, a tangle of vessels, and numerous large draining veins favoring a diagnosis of congenital arteriovenous malformation. Color Doppler shows vessels with low resistive index and high peak systolic velocity flow pattern. Both ovaries are normal in size (right ovary: 2.2 x 2.7 cm; left ovary: 1.4 x 1.9 cm) with normal echotexture and no focal lesions. Both adnexa are free from mass, but tubular vascular channels are profound. There is no free fluid in the pelvis.
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case_images: FIG2
case_images: The findings were consistent with uterine congenital AVM (Figure 2).
case_images: An angiogram of the left uterine artery showing multiple irregular pathological vessels. The coil was inserted at the origin of the anastomotic branch connecting the left ovarian artery to the left uterine artery and embolized using microparticles.
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case_images: FIG3
case_images: Following this, the microcatheter was advanced until reaching the left uterine artery and microparticles were used to embolize it (Figure 3).
case_images: Right uterine artery angiogram showing hypertrophic right uterine artery with multiple pathological vessels with direct shunting into the veins. The coil was inserted in the right uterine artery and then the uterine artery was embolized using Onyx.
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case_images: FIG4
case_images: On the right side, a coil was inserted at the origin of the right uterine artery to slow the flow within the feeding vessel, followed by using Onyx, a non-adhesive liquid embolic agent (Figure 4).
case_images: Post embolization angiogram showing complete occlusion of the pathological arteries feeding the UAVM, reverse flow within the left ovarian vein causing varicosity within the pelvis is identified.
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case_images: FIG5
case_images: AVM (Figure 5). A pigtail catheter was advanced into the abdominal aorta. An angiogram showed reverse flow within the left ovarian vein causing varicosity within the pelvis in the venous phase (Figure 5). Post-embolization angiogram showed complete occlusion of the pathological arteries feeding the AVM (Figure 5).
case_images: Pelvis MRI with contrast post-uterine artery embolization showing a thrombsed arteriovenous malformation in the right parametrium and left parametrial serpentine vascular channels with contrast enhancement, suggestive of persistent activity.
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case_images: FIG6
case_images: The patient underwent an MRI of the pelvis with contrast two months after the UAE procedure (Figure 6).