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Arteriovenous Malformation (AVM) – Companion Case

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This is a companion case to our AVM.

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In this particular case, we only

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needed to do transabdominal.

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We have a bladder full.

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We could see our uterus pretty well.

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And you can see there's a lot of

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heterogeneity up towards the fundus,

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and a lot of color Doppler flow.

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We put a lot of different spectral Dopplers on

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her to try and figure out what was going on.

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This waveform's a bit of a high resistance.

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We got up to 67 centimeters per second.

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As we kept going trying to find these, our

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peak velocities kept getting higher and higher.

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And she was someone who had suffered a

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miscarriage and had continual bleeding

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afterwards and had transvaginal imaging

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showing what looked like an AVM.

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So prior to going to CVIR, we again tried

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to get these peaks to stop velocities to

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see if she would benefit from conservative

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therapy, just watching and waiting.

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But since her velocities were up to the

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200th, we felt that this would not and that

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she was a good candidate for intervention.

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This was actually used, what

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we did here, was a B mode.

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This is not a contrast ultrasound,

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but it does provide pretty neat

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vascular images without contrast.

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And in this particular case, what we

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thought it helped was that our, our

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velocities we were getting early on,

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you couldn't angle correct necessarily.

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We were just sort of guessing.

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You know, there's so much color

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Doppler flow, it's hard to tell exactly

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which way we should put that box.

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But when we did the B flow images, you

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could get a better idea of which way

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that vessel was flowing, so we could

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angle correct a little bit better.

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And that's when we started getting

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these much higher vascular flows,

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which we felt better represented what

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was actually going on in her case.

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Here's a pre-procedural planning CTA.

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And again, just to show you how vascular

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it is, and it's all sort of in the fundus

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and a little bit anterior right here.

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That's what she looked like there.

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All those tangles of vessels.

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Right there.

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And then finally, she went to angio and you

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can again see here this tangle of blood vessels.

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To go back to the beginning of that feels very

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early, but there's a larger kind of cystic

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AVM itself, that larger nidus of the AVM here.

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So she was embolized and did quite well

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after this as well. Her AVM also got much

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smaller in size and all of her velocities

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went down to more normal levels as well.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Vascular

Uterus

Ultrasound

Iatrogenic

Gynecologic (GYN)

Body

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