Department of Obstetrics and Gynecology Assaf Harofe Medical Center, Zerifin, Israel.
Ultraschall Med. 2011 Dec;32 Suppl 2:E92-9. doi: 10.1055/s-0031-1273274. Epub 2011 May 25.
The purpose of this article was to investigate clinical ultrasonographic findings and the outcomes of post-pregnancy patients with acquired uterine vascular abnormalities including arteriovenous malformations (AVMs).
We performed a computerized database search for all patients with ultrasonographic findings of a vascular abnormality including AVM in our referral center between 2000-2008. An ultrasound finding of vascular abnormality was defined as an area of strong hypervascularity within the myometrium and the presence of marked turbulence. The inclusion criteria for angiography were abnormal vaginal bleeding in a hemodynamically stable patient, bhCG serum levels ≤ 30 mIU/ml, and ultrasound demonstration of large (≥ 15 mm on the larger side of the vessel) or multiple vascular lesions.
16 women were identified, of whom 10 (63 %) underwent uterine artery embolization. Angiography confirmed the pre-interventional ultrasound diagnosis of AVM in all cases. AVM feeding arteries were on the left side of the uterus in 80 % of the cases. Residual tissue was ultrasonographically detected in five patients: 2 underwent hysteroscopy and guided curettage following embolization and three received methotrexate. All tissue samples were benign. One small vascular abnormality resolved spontaneously.
An acquired uterine vascular abnormality including AVM should be considered in the work-up of post-pregnancy vaginal bleeding.
本文旨在研究产后获得性子宫血管异常（包括动静脉畸形）患者的临床超声表现和结局。
我们对 2000 年至 2008 年期间在我们的转诊中心进行的所有超声表现为血管异常（包括动静脉畸形）的患者进行了计算机数据库检索。血管异常的超声表现定义为子宫肌层内强高血管区域和明显湍流的存在。血管造影的纳入标准为血流动力学稳定的患者出现异常阴道出血、bhCG 血清水平≤30mIU/ml 以及超声显示大（血管较大侧≥15mm）或多发血管病变。
共确定 16 名女性，其中 10 名（63%）接受了子宫动脉栓塞术。血管造影术在所有病例中均证实了术前超声诊断为动静脉畸形。80%的病例中，动静脉畸形的供血动脉位于子宫左侧。5 名患者的残留组织在超声下被检测到：2 名患者在栓塞后接受了宫腔镜和引导刮宫，3 名患者接受了甲氨蝶呤治疗。所有组织样本均为良性。一个小的血管异常自发消退。
在产后阴道出血的检查中，应考虑到获得性子宫血管异常（包括动静脉畸形）。
