1
|
Jannusch K, Steuwe A, Schimmöller L, Dietzel F, Wilms LM, Weiss D, Ziayee F, Fehm TN, Schlimgen C, Poth V, Ziegler RT, Minko P. Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report. CVIR Endovasc 2023; 6:50. [PMID: 37870638 PMCID: PMC10593720 DOI: 10.1186/s42155-023-00398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND True uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial. CASE PRESENTATION We present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus. CONCLUSIONS Unruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.
Collapse
Affiliation(s)
- Kai Jannusch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany.
| | - Andrea Steuwe
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Lars Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Frederic Dietzel
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Lena M Wilms
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Daniel Weiss
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Farid Ziayee
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Tanja Natascha Fehm
- Medical Faculty, Department of Gynecology, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Charlotte Schlimgen
- Medical Faculty, Department of Gynecology, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Vanessa Poth
- Department of Gynecology, Hermann-Josef Hospital, Erkelenz, D-41812, Germany
| | - Reinhold Thomas Ziegler
- Medical Faculty, Department of Vascular and Endovascular Surgery, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Peter Minko
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| |
Collapse
|
2
|
An Unruptured True Aneurysm of the Uterine Artery during Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12102459. [PMID: 36292147 PMCID: PMC9600217 DOI: 10.3390/diagnostics12102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
The antenatal diagnosis of an unruptured true aneurysm of the uterine artery is extremely rare and has never been reported, whereas pseudoaneurysms associated with previous trauma or cesarean section have been reported several times. True aneurysms occur when the artery or vessel weakens and bulges, sometimes forming a blood-filled sac. Nearly all cases of pelvic true aneurysms involved ovarian arteries which ruptured during the peripartum period. The case presented here is unique in terms of being an unruptured true aneurysm of the uterine artery with a first diagnosis during pregnancy at 32 weeks of gestation and the spontaneous development of thrombosis in the aneurysm in late pregnancy, documented at 37 weeks of gestation. The diagnosis of a true aneurysm of the uterine artery was based on, (1) a demonstration of the cystic mass located in proximity to the lower segment of the uterus with ultrasound characteristics of arterial flow in the mass, and (2) the occurrence in a woman who had no history of trauma or surgery in the pelvis. The finding during cesarean section confirmed the prenatal sonographic finding. The pregnancy ended with successful outcomes.
Collapse
|
3
|
Spontaneous Uterine Vessel Rupture During Pregnancy or in the Puerperium: A Review of the Literature. Obstet Gynecol Surv 2022; 77:227-233. [PMID: 35395092 DOI: 10.1097/ogx.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Spontaneous perinatal rupture of a uterine vessel is a rare occurrence that may lead to severe hemorrhage and requires prompt identification and management. Objective The aim of this study was to examine the etiologies, locations, diagnostic tools, treatment options, and risks in subsequent pregnancies when spontaneous rupture of a uterine vessel occurs in pregnancy. Evidence Acquisition A literature search was performed by university research librarians using the PubMed, CINAHL, and Web of Science search engines. Identified were 78 cases of perinatal spontaneous uterine vessel rupture and formed the basis for this review. Results Increased uterine blood flow during pregnancy may alter the integrity of pelvic vessels leading to increased risk of spontaneous rupture. The uterine artery is the most common site of vessel rupture; the second most common site is the uterine-ovarian plexus. The most common presentation is abdominal or pelvic pain, maternal vital sign abnormalities, and an absence of vaginal bleeding. Exploratory laparotomy and embolization (interventional radiology) have been reported as management options. Conclusions Spontaneous rupture of uterine vessels is a rare but potentially life-threatening complication of pregnancy that should be included in the differential diagnosis of pregnant patients presenting with an acute abdomen. Relevance Our aim is to increase the awareness of spontaneous vessel rupture during pregnancy to improve detection, management, and perinatal outcomes.
Collapse
|
4
|
True Aneurysm of Ovarian and Uterine Arteries:a Comprehensive Review. Ann Vasc Surg 2020; 72:610-616. [PMID: 33227474 DOI: 10.1016/j.avsg.2020.09.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gonadal artery aneurysm represents an extremely rare condition often unrecognized until rupture. METHODS A literature review was undertaken on Pubmed from 1990 to 2020 to identify reported cases of ovarian and uterine artery aneurysms, including the index case presented here. Data about the clinical presentation, diagnostic approach, and treatment were collected. RESULTS Twenty-one articles reporting on data about 22 patients, including the index case, were included. The patients's median age was 46.7 years (range 30-80) and aneurysm maximal diameter 2.6 cm (range 0.75-5 cm). Except for one asymptomatic patient, the aneurysm's clinical presentation was abdominal/back pain in the majority of cases (n = 20, 90.9%). Rupture with retroperitoneal hematoma occurred in 16 cases (72.7%) and hemorrhagic shock in one case (4.5%). No history of vaginal bleeding was reported in any case. The majority of the aneurysms were diagnosed in women of childbearing age: in 50% (n = 11) of cases during the peripartum period and in 22.7% (n = 5) of cases during the postmenstruation period. The remaining cases (n = 6, 27.3%) were detected during the postmenopausal period. The majority of patients (n = 15, 68.2%) were emergently treated with an endovascular approach by embolization, achieving the total exclusion of the aneurysm in 86.7% of cases (13 patients). In 7 cases (31.8%), surgical ligation was performed, of which 2 (9.1%) were for the failure of a primarily attempted coils embolization. The spontaneous thrombosis of the uterine aneurysm was noted 3 months after the initial diagnosis in one patient. CONCLUSIONS The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results.
Collapse
|
5
|
Usman R, Jamil M, Rasheed M. True Aneurysm of the Uterine Artery in a Young Nulliparous Female: An Extremely Rare Vascular Entity. Ann Vasc Dis 2018; 11:542-544. [PMID: 30637012 PMCID: PMC6326040 DOI: 10.3400/avd.cr.18-00066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present the first case of a large true uterine artery aneurysm, with a 5-cm diameter, in a 35-year-old nulliparous woman who presented with lower abdominal pain and dyspareunia. She underwent successful ligation and excision of the aneurysm using the Pfannenstiel approach. The diagnostic modalities and treatment option for such a case is discussed herein.
Collapse
Affiliation(s)
- Rashid Usman
- Department of Vascular Surgery Combined Military Hospital & Midcity Hospital, Lahore, Pakistan
| | - Muhammad Jamil
- Department of Surgery Combined Military Hospital, Peshawar Cantt, Pakistan
| | | |
Collapse
|
6
|
Reimnitz L, Sanchez-Migallon Guzman D, Alex C, Summa N, Gleeson M, Cissell DD. Multiple endometrial venous aneurysms in a domestic rabbit ( Oryctolagus cuniculus ). J Exot Pet Med 2017. [DOI: 10.1053/j.jepm.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Jesinger RA, Thoreson AA, Lamba R. Abdominal and Pelvic Aneurysms and Pseudoaneurysms: Imaging Review with Clinical, Radiologic, and Treatment Correlation. Radiographics 2013; 33:E71-96. [DOI: 10.1148/rg.333115036] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
8
|
Gavanier D, Orsoni M, Dupuis O, Valette PJ. [Spontaneous hemoperitoneum during pregnancy and uterine artery aneurysm]. ACTA ACUST UNITED AC 2012; 40:711-4. [PMID: 23099023 DOI: 10.1016/j.gyobfe.2012.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/12/2012] [Indexed: 11/30/2022]
Abstract
Spontaneous hemoperitoneum is not frequent. We report here a rare cause of spontaneous hemoperitoneum during the second trimester of pregnancy. A ruptured uterine artery aneurysm was revealed in a patient who came for important abdominal pain. A CT scan showed a large hemoperitoneum and an additional arterial image. The patient underwent rapidly an embolization, which allowed a complete closure of the aneurysm. The patient gave birth to a healthy child. The diagnosis of hemoperitoneum must be discussed without delay. Once imagery realised, a good management of the patient must be done depending on the origin of the hemoperitoneum.
Collapse
Affiliation(s)
- D Gavanier
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalo-universitaire de Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | | | | | | |
Collapse
|
9
|
Munir SI, Lo T, Seaton J. Spontaneous rupture of utero-ovarian vessels in pregnancy. BMJ Case Rep 2012; 2012:bcr0220125904. [PMID: 22669867 PMCID: PMC4542847 DOI: 10.1136/bcr.02.2012.5904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous rupture of utero-ovarian vessels in pregnancy is rare and usually involves utero-ovarian veins. Presenting symptoms include acute-onset abdominal pain and maternal hypovolemic shock secondary to haemoperitoneum. Although this condition had been documented over a century ago, an accurate diagnosis is rarely reached prior to laparotomy due to a multitude of other surgical and obstetrical presentations that may pose a similar clinical picture. In such an event an emergency exploratory laparotomy followed by caesarean section with ligation of the uterine vessels can help in preventing a maternal mortality.
Collapse
|