Presentation
Dysfunctional uterine bleeding.
Patient Data
The uterus is enlarged measuring 11 x 9.4 x 5.8 cm. It shows multiple prominent intra-uterine serpentine vasculature. A rather defined (5cm) irregular lesion is noted at the right lateral wall, displaying T1 and T2 hyperintense signal, with diffusion restriction. Following IV contrast injection. It shows hypo enhancement, in keeping with intraparenchymal uterine hematoma.
It is continuous with thick wall recto-uterine space collection noted 11 x 7.8 x 2.6 cm, displaying T1 and T2 hyperintense signal with mild peripheral enhancement. Evident restriction on DWI/ADC, in keeping with late subacute hematoma. Smaller similar lesion seen at the left wall measuring 1.2 cm.
Multiple small cervical Nabothian cysts.
LV5/SV1 minimal spondylolisthesis, with diffuse posterior pseudo disc bulge
Case Discussion
MRI features suggestive of uterine vascular malformation resulting in right-sided intrauterine myometrial late subacute hematoma and extending into the Douglas pouch. Uterine bleeding is the major presenting symptom in uterine AVMs, which can be massive and life-threatening in young women.
Case courtesy Prof. Dr. Ihab Reda, professor of radiodiagnosis, Alexandria university, Egypt.
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