title: Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes.
abstract: OBJECTIVE
  To retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors.
  
  
  METHODS
  Between 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19-62). Follow-up was 32 months in mean (1-78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n=2), MR (n=5) and angiographic (n=26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors.
  
  
  RESULTS
  No information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p=0.001). The hemoglobin level was significantly lower (below 11 g/L) in these cases (p=0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p=0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2-23).
  
  
  CONCLUSIONS
  Recurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients.
authors.affiliation: Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Hugues
authors.affiliation: Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Bras
authors.affiliation: Department of Gynecology and Obstetrics, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Coatleven
authors.affiliation: Department of Gynecology and Obstetrics, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Brun
authors.affiliation: Department of Radiology, St André Hospital, 1 Place Jean Burguet, 33076 Bordeaux, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Trillaud
authors.affiliation: Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grenier
authors.affiliation: Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France. Electronic address: francois.cornelis@chu-bordeaux.fr.
authors.forename: François
authors.initials: F
authors.lastname: Cornelis
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications; D001165:Arteriovenous Malformations / Q000150:complications / Q000628:therapy*; D003475:Curettage; D003952:Diagnostic Imaging; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007047:Hysterosalpingography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014564:Urogenital Abnormalities / Q000150:complications / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000150:complications / Q000628:therapy; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult
keywords: Arteriovenous malformation; Curettage; Embolization; Pregnancy; Uterus hemorrhage