Clin Case Rep Int | Volume 7, Issue 1 | Case Series | Open Access
Delgado-Morell A1,2*, Peró M1,2, Estadella J1,2, Llurba E1,2, Guerrero R1,3 and Rams M1,2
1Institute of Biomedical Research Sant Pau (IIB SANT PAU), Barcelona, Spain
2Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
3Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
*Correspondance to: Aina Delgado-MorellFulltext PDF
Retained Products of Conception (RPOC) and Arteriovenous Malformations (AVM) are relevant causes of Postpartum Hemorrhage (PPH) which can be potentially life-threatening when treatment is deferred or when surgically mistreated due to wrong differential diagnosis. Ultrasound (US) has a key role in the diagnosis of both entities, and can be useful when planning the therapeutic approach and assess the risk of severe bleeding. The presented case-reports illustrate both entities and the difficulties faced in its differential diagnosis, as well as the utility of US on their detection and management. On the first case, patient presented the typical clinical features and risk factors of AVM. The US findings included the classical highly-specific signs: Multiple hypoechoic myometrial spaces with multidirectional turbulent high velocity flow seen on color Doppler US, and prominent parametrial vessels. On the second case, the clinical presentation and the background of curettages prior to the current pregnancy led the medical team to initially suspect AVM, even when the patient did present the three sonographic signs with higher PPV for RPOC diagnosis: A welldefined endometrial mass, a thickened endometrium, and endometrial vascularization. Key point on US differential diagnosis between the two entities is the presence of endometrial vascularization vs. exclusively myometrial vascularization.
Delgado-Morell A, Peró M, Estadella J, Llurba E, Guerrero R, Rams M. The Importance of Ultrasound in the Differential Diagnosis of Acquired Arterio-Venous Malformation and of Retained Products of Conception: Two Similar Cases with Distinct Etiology and Management. Clin Case Rep Int. 2023; 7: 1458.