Rare case of a massive uterine arteriovenous fistula

A 64-year-old postmenopausal woman presented with a 1-day history of severe vaginal bleeding. She denied abdominal pain and dizziness. No signs or symptoms of high-output heart failure, except for 90 beats per minute heart rate at rest. A molar pregnancy 20 years earlier was treated with dilation and curettage, followed by systemic therapy with methotrexate and folinic acid. A uterine arteriovenous fistula was discovered and managed conservatively for many years because it was asymptomatic.

Ultrasound demonstrated tubular structures in and about the uterus with low-resistance arterial waveforms. Computerized tomography showed enormous ovarian and uterine arteries, and hypogastric and right ovarian veins with early contrast enhancement ( Figure 1 ).