Clarke Joseph Adam, Viswanatha Radhika Kashi, Hamid Rosol, Sankaranarayanan Subha
St George's University of London, London, UK.
BMJ Case Rep. 2012 Dec 4;2012:bcr2012007368. doi: 10.1136/bcr-2012-007368.
A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'. She required blood transfusions on multiple admissions, was forced to resign from her job and later became depressed. Under our care a transvaginal ultrasound scan showed a hypervascular region on the posterior uterine wall. An urgent hysteroscopy was performed due to her haemoglobin being 5.7 g/dl and revealed a pulsating lesion abutting the endometrium, which can be seen here on video. MR angiography confirmed an arteriovenous malformation and she was successfully treated with uterine artery embolisation.
一位23岁女性，在接受人工流产手术后，出现了长达10个月的多次月经延长且不规律出血的情况。最初，盆腔超声和宫腔镜检查均显示正常，在数月时间里，她接受了功能失调性子宫出血的药物治疗。她还尝试过铜宫内节育器和曼月乐宫内节育系统，但均因大量出血（“拳头大小的血块”）而排出。她多次住院输血，被迫辞职，后来变得抑郁。在我们的治疗下，经阴道超声扫描显示子宫后壁有一个高血管区域。由于她的血红蛋白为5.7 g/dl，紧急进行了宫腔镜检查，发现一个紧靠子宫内膜的搏动性病变，视频中可见。磁共振血管造影证实为动静脉畸形，她通过子宫动脉栓塞术成功治愈。
