PDF(Pubmed)
Abstract：
UNASSIGNED: Uterine artery pseudoaneurysm (UAP) is a rare cause of late postpartum hemorrhage. Insufficient understanding of this condition among clinicians may result in delayed diagnosis and treatment, potentially leading to incorrect interventions and poor prognosis, including fatal hemorrhage and even necessitating hysterectomy in severe cases.
UNASSIGNED: The patient, a 41-year-old woman with a history of three pregnancies and two deliveries, underwent cesarean section and subsequently experienced persistent small amounts of vaginal bleeding for a duration of two months. Transvaginal ultrasonography revealed a hypoechoic mass in the cervix that was initially misdiagnosed as a cervical fibroid. Approximately 12 h prior to admission, she experienced an episode of acute vaginal bleeding of significant intensity. Emergency transvaginal ultrasound demonstrated an intrauterine mass located in the posterior wall of the cervix with swirling blood flow, exhibiting a to-and-fro pattern. The mass was connected to the left uterine artery adjacent to the cervix through a tear measuring approximately 0.5 cm in diameter. Emergency bilateral uterine artery embolization was performed. After a follow-up period of ten months, there was no recurrence of abnormal vaginal bleeding, and subsequent ultrasound examination confirmed the complete resolution of the cervical lesions.
UNASSIGNED: The findings of this case suggest that the UAP undergoes a dynamic process. In the early stages, the lesion may manifest as a small hypoechoic or anechoic area within the myometrium. Color Doppler imaging might not reveal blood flow signals within the lesion, potentially leading to misdiagnosis as other common uterine lesions such as fibroids or cysts. However, considering the close association between UAP and the uterine artery, meticulous observation of the relationship between the uterine artery and its branches is crucial for identifying myometrial lesions to facilitate early detection of UAP and minimize misdiagnosis.
UNASSIGNED: The patient, a 41-year-old woman with a history of three pregnancies and two deliveries, underwent cesarean section and subsequently experienced persistent small amounts of vaginal bleeding for a duration of two months. Transvaginal ultrasonography revealed a hypoechoic mass in the cervix that was initially misdiagnosed as a cervical fibroid. Approximately 12 h prior to admission, she experienced an episode of acute vaginal bleeding of significant intensity. Emergency transvaginal ultrasound demonstrated an intrauterine mass located in the posterior wall of the cervix with swirling blood flow, exhibiting a to-and-fro pattern. The mass was connected to the left uterine artery adjacent to the cervix through a tear measuring approximately 0.5 cm in diameter. Emergency bilateral uterine artery embolization was performed. After a follow-up period of ten months, there was no recurrence of abnormal vaginal bleeding, and subsequent ultrasound examination confirmed the complete resolution of the cervical lesions.
UNASSIGNED: The findings of this case suggest that the UAP undergoes a dynamic process. In the early stages, the lesion may manifest as a small hypoechoic or anechoic area within the myometrium. Color Doppler imaging might not reveal blood flow signals within the lesion, potentially leading to misdiagnosis as other common uterine lesions such as fibroids or cysts. However, considering the close association between UAP and the uterine artery, meticulous observation of the relationship between the uterine artery and its branches is crucial for identifying myometrial lesions to facilitate early detection of UAP and minimize misdiagnosis.
摘要：
■子宫动脉假性动脉瘤（UAP）是晚期产后出血的罕见病因。临床医生对这种情况的认识不足可能会导致延误诊断和治疗，可能导致不正确的干预措施和不良预后，包括致命的出血，甚至在严重的情况下需要子宫切除术。
■病人,一名41岁的妇女，有三次怀孕和两次分娩的历史，接受了剖宫产手术,随后经历了持续2个月的持续少量阴道出血.经阴道超声检查发现子宫颈有低回声肿块，最初被误诊为宫颈肌瘤。入院前大约12小时，她经历了严重的急性阴道出血。紧急经阴道超声显示子宫内肿块位于子宫颈后壁，血流漩涡，表现出来回的模式。肿块通过直径约0.5cm的撕裂与子宫颈附近的左子宫动脉相连。行急诊双侧子宫动脉栓塞术。经过十个月的随访,没有复发异常阴道出血,随后的超声检查证实宫颈病变完全消退。
■这种情况的发现表明UAP经历了一个动态过程。在早期阶段,病变可能表现为子宫肌层内的小的低回声或无回声区域。彩色多普勒成像可能无法显示病变内的血流信号，可能导致误诊为其他常见的子宫病变，如肌瘤或囊肿。然而,考虑到UAP和子宫动脉之间的紧密联系，仔细观察子宫动脉及其分支之间的关系对于识别子宫肌层病变至关重要，以利于早期发现UAP并减少误诊。
■病人,一名41岁的妇女，有三次怀孕和两次分娩的历史，接受了剖宫产手术,随后经历了持续2个月的持续少量阴道出血.经阴道超声检查发现子宫颈有低回声肿块，最初被误诊为宫颈肌瘤。入院前大约12小时，她经历了严重的急性阴道出血。紧急经阴道超声显示子宫内肿块位于子宫颈后壁，血流漩涡，表现出来回的模式。肿块通过直径约0.5cm的撕裂与子宫颈附近的左子宫动脉相连。行急诊双侧子宫动脉栓塞术。经过十个月的随访,没有复发异常阴道出血,随后的超声检查证实宫颈病变完全消退。
■这种情况的发现表明UAP经历了一个动态过程。在早期阶段,病变可能表现为子宫肌层内的小的低回声或无回声区域。彩色多普勒成像可能无法显示病变内的血流信号，可能导致误诊为其他常见的子宫病变，如肌瘤或囊肿。然而,考虑到UAP和子宫动脉之间的紧密联系，仔细观察子宫动脉及其分支之间的关系对于识别子宫肌层病变至关重要，以利于早期发现UAP并减少误诊。
