Antepartum diagnosis of pelvic arteriovenous malformation.
BACKGROUND
An arteriovenous fistula in the female pelvis is a rare finding. We report a pelvic arteriovenous fistula diagnosed antepartum.


METHODS
At 38 weeks' gestation, a 32-year-old woman, gravida 3, para 1, was found on bimanual examination to have a pulsating mass on the left vaginal sidewall. Magnetic resonance imaging revealed a tangle of arteries feeding into an aneurysmal dilation of a branch vein of the left internal iliac, extending to the left lateral wall of the cervix and vagina, and ending in a large varix in the lateral wall of the vagina. The patient was asymptomatic and underwent primary cesarean delivery of a healthy female infant. Twice during her postpartum course, she underwent angiography and embolization of extensive left- and right-sided feeding vessels. Five to 6 weeks after each embolization, the vaginal mass recurred.


CONCLUSIONS
A pelvic arteriovenous malformation diagnosed antepartum presents a dilemma in regards to risk of hemorrhage, congestive heart failure, and successful ablation.
Ramin
K D
KD
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Ramin
S M
SM
Webb
L S
LS
Radford
L R
LR
Sewall
L E
LE
D000328:Adult; D000792:Angiography; D001164:Arteriovenous Fistula / Q000151:congenital / Q000175:diagnosis* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D010388:Pelvis / Q000098:blood supply*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000628:therapy