A 36 yo woman with Hgb SC presents with heavy vaginal bleeding requiring transfusion

her imaging is shown below. What does she have?

Our patient had a uterine AVM. A bleeding vessel was seen on CT.  She had been bleeding for two days and dropped her Hgb in spite of transfusions.  She was incidentally COVID.+ although had no symptoms of COVID.

This is an unusual cause of vaginal bleeding.   The first case of a uterine AVM was described in 1926.  The AVM consists of a proliferation of arterial and venous channels with fistula formation . The AVM may be either congenital or acquired.  Acquired AVMs are more common and  follow a history of uterine trauma, such as C section, D+C or pelvic surgery.  The potential to develop abnormal connections occurs during the healing process when a single artery  joins a single vein.  Acquired AVM is also associated with infection, retained products, gestational trophoblastic disease , malignances and exposure to diethylstilbestrol.

Uterine AVM can also be diagnosed on US

The treatment of uterine AVMs in the past was hysterectomy. This has been replaced by embolization of the AVM.  Our patient had a successful embolization and was discharged.

Polat P, Suma S, Kantarcy M, et al. Colour Doppler ultrasounc in the evaluation of uterine vascular abnormalities. Radiographics. 2002:22:47-53.

Frivell R, Reid K , Mellor A. Uterine arteriovenous malformations: a review of the current literature . Obstet Gynaecol Survery.  2005;60(11):761-767.

Hashim H, Nawawi O.  Uterine Arteriovenous malformation. Malys J Med Sci 2013 Mar; 20(20:76-80.