Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2025; 13(9): 99671
Published online Mar 26, 2025. doi: 10.12998/wjcc.v13.i9.99671
Differential diagnosis of uterine vascular anomalies: Uterine pseudoaneurysm as a cause of massive hemorrhage
Teresa Gastañaga-Holguera, Isabel Campo Gesto, Laura Gómez-Irwin, Marta Calvo Urrutia
Teresa Gastañaga-Holguera, Isabel Campo Gesto, Marta Calvo Urrutia, Department of Obstetrics and Gynecology, San Carlos Clinical Hospital, Madrid 28040, Spain
Laura Gómez-Irwin, Department of Gastroenterology, University Hospital of Cruces, Baracaldo 48903, Bizkaia, Spain
Author contributions: Gastañaga-Holguera T, Campo Gesto I, and Calvo Urrutia M were responsible for the design of the work and drafting; Gómez-Irwin L was responsible for the drafting and native English review; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Teresa Gastañaga-Holguera, MD, PhD, Department of Obstetrics and Gynecology, San Carlos Clinical Hospital, Martín Lagos, Madrid 28040, Spain. teresagastanaga@gmail.com
Received: July 27, 2024
Revised: November 18, 2024
Accepted: December 2, 2024
Published online: March 26, 2025
Processing time: 137 Days and 20.3 Hours
Abstract

In this article, we comment on the paper by Kakinuma et al published recently. We focus specifically on the diagnosis of uterine pseudoaneurysm, but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine pseudoaneurysms. Uterine artery pseudoaneurysm is a complication of both surgical gynecological and non-traumatic procedures. Massive hemorrhage is the consequence of the rupture of the pseudoaneurysm. Uterine artery pseudoaneurysm can develop after obstetric or gynecological procedures, being the most frequent after cesarean or vaginal deliveries, curettage and even during pregnancy. However, there are several cases described unrelated to pregnancy, such as after conization, hysteroscopic surgery or laparoscopic myomectomy. Hemorrhage is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and treatment. However, there are other uterine vascular anomalies that may be the cause of severe hemorrhage, which must be taken into account in the differential diagnosis. Computed tomography angiography and embolization is supposed to be the first therapeutic option in most of them.

Keywords: Uterine artery pseudoaneurysm; Vascular anomaly; Uterine vascular malformation; Massive hemorrhage; Postpartum hemorrhage; Angiography; Uterine embolization; Transarterial embolization

Core Tip: Uterine pseudoaneurysm can develop after delivery but there are several cases unrelated to pregnancy and obstetricians, such as conization, hysteroscopic surgery or laparoscopic myomectomy and gynecologists and radiologists should be aware of it. There are another uterine vascular anomalies that also may cause life-threatening hemorrhage, so awareness and suspicion is essential for early diagnosis and treatment. Doppler ultrasound is used for initial diagnosis, and magnetic resonance imaging and computed tomography angiography are valuable methods to confirm the presence of the anomaly.