AVM IN CESAREAN SCAR-USG

Uterine arterio-venous malformation (AVM) is uncommon cause of uterine bleeding.  Reported here is rare case of arteriovenousmalformation in lower section cesarean scar diagnosed with color Doppler. Submitted by: Dr. Subhash Tailor, MD Consultant Radiologist in Bhilwara [ Rajasthan]

A 32  year old female ,with one live issue , presented  with profuse episodic bleeding per vaginum. Her last childbirth (by caesarean section) was 2 years ago. There was no past history of menorrhagia. On examination, there was pallor and she was anaemic.

Pelvic gray scale ultrasound showed small anechoic cystic spaces in anterior myometrium of lower part of body of uterus at the level of previous cesarean section (Figure 1).

Figure 1: TVS scan shows  multiple small anechoic cystic spaces in anterior myometrium of lower part of body of uterus at the level of previous cesarean section [ arrow ].

Colour Doppler US scan showed color signals in these cystic areas with intense mosaic flow with colour aliasing  apparent ..(Figure 2).

Figure 2: TVS Colour Doppler US scan showing intense flow with colour aliasing and
apparent tangle of  flow  channels .

The spectral Doppler reveals the classic features of arteriovenous shunting i.e. high PSV, low pulsatility of arterial waveform, pulsatile high velocity venouswaveforms with little variations in systolic – diastolic velocities.(Figure 3).

Figure 3:Spectral Doppler revealing classic  arterio-venous shunting.