A comprehensive diagnostic approach to differentiate intrauterine arteriovenous malformation in cases of enhanced myometrial vascularity

IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Archives of Gynecology and Obstetrics Pub Date : 2024-09-28 DOI:10.1007/s00404-024-07754-1
Carolina Ercolino, Enrico Ferrazzi, Manuela Wally Ossola, Eugenia Di Loreto, Pierpaolo Biondetti, Serena Carriero, Ottavio Cassardo, Carolina Lanza, Francesco D’Ambrosi
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Abstract

Purpose

The differentiation between conditions such as uterine arteriovenous malformation, pseudoaneurysm, gestational trophoblastic disease, and retained trophoblastic tissue can be challenging. Ultrasound imaging and Doppler interrogation are the primary diagnostic tools to assess cases of enhanced myometrial vascularity and differentiate intrauterine vascular anomalies. However, some cases remain of difficult differentiation. This study aims to analyze suspected cases and describe their diagnostic management and outcomes.

Methods

We reviewed post-abortion cases that underwent pelvic transvaginal U/S imaging and Doppler examinations due to suspected uterine vascular anomalies. CT scans were performed in cases in which ultrasound did not reach a diagnosis. Simple follow-up, medical or surgical therapy, or embolization of uterine arteries were performed according to the final diagnosis.

Results

From 2015 to 2022, we retrieved from electronic ultrasound records 22 cases of suspected vascular malformations. In eight cases, first-line U/S at admission excluded the suspected anomaly. In Five of the remaining 14 patients, uterine vascular anomalies were excluded upon a second-level  U/S based on angio-Doppler imaging and Doppler peak velocity interrogation. Nine cases underwent CT scan, and a digital angiography and embolization were performed in eight of these cases, of whom only two had a documented uterine arteriovenous malformation.

Conclusion

Our triage proved that only two out of 22 suspected cases had a uterine arteriovenous malformation. This diagnosis is frequently misused in clinical practice. Our data confirm that enhanced myometrial vascularity should be used to encompass the spectrum of possible differential diagnosis. A precise step-by-step diagnostic method is of paramount importance to prevent unnecessary interventions.

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在子宫肌层血管增强的病例中鉴别宫内动静脉畸形的综合诊断方法。
目的:区分子宫动静脉畸形、假性动脉瘤、妊娠滋养细胞疾病和滋养细胞组织滞留等情况具有挑战性。超声成像和多普勒检查是评估子宫肌层血管增强病例和区分宫内血管异常的主要诊断工具。然而,仍有一些病例难以区分。本研究旨在分析疑似病例,并描述其诊断处理和结果:我们回顾了因怀疑子宫血管异常而接受盆腔经阴道U/S成像和多普勒检查的人工流产后病例。在超声检查未能确诊的病例中进行了 CT 扫描。根据最终诊断结果进行简单的随访、药物或手术治疗或子宫动脉栓塞:2015年至2022年,我们从电子超声记录中检索到22例疑似血管畸形病例。其中8例患者入院时的一线U/S检查排除了疑似畸形。其余14例患者中,有5例在进行二级U/S检查时,根据血管多普勒成像和多普勒峰值速度检查排除了子宫血管畸形。9 例患者接受了 CT 扫描,其中 8 例患者接受了数字血管造影和栓塞治疗,只有 2 例患者被证实为子宫动静脉畸形:结论:我们的分诊结果表明,22 例疑似病例中只有 2 例患有子宫动静脉畸形。这一诊断在临床实践中经常被误用。我们的数据证实,增强的子宫肌层血管应被用来涵盖可能的鉴别诊断范围。精确的逐步诊断方法对于防止不必要的干预至关重要。
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来源期刊
CiteScore
4.70
自引率
15.40%
发文量
493
审稿时长
1 months
期刊介绍: Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.
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