Differential diagnosis of uterine vascular anomalies: Uterine pseudoaneurysm as a cause of massive hemorrhage

Table 1 Uterine vascular anomalies

Characteristics	Uterine pseudoaneurysm	Arteriovenous malformation	Arteriovenous fistula	Uterine hemangioma
Patient history	Vascular malformation; gynecological procedures: Curettage, conization, hysterectomy, and laparoscopy	Vascular malformation; congenital, acquired: Curettage, uterine surgery	Vascular malformation; previous uterine trauma	Vascular tumour; congenital: Associated to syndromes; acquired: Pregnancy/delivery
Signs and symptoms	Pain, fever, genital bleeding/hydronephrosis (depending on type)	Miscarriages, menorrhagia	Irregular uterine bleeding/massive hemorrhage; pelvic, vaginal, rectal, pain	Pain, vaginal hemorrhage
Risks	Rupture (hemorrhage)	Vaginal or intra-abdominal hemorrhage	Catastrophic hemorrhage	Postpartum hemorrhage, DIC
Diagnosis	Doppler US, CT, MRI	Doppler US, CT, MRI; gold standard: Angiography	Doppler US, CT or MRI	CT, MRI, angiography
Management	-	Conservative vs surgical intervention or embolization	Endovascular or open surgery	Vaginal delivery is preferred
Treatment	Angiography and uterine artery embolization	Embolization	Embolization of the communication (communicating artery?)	Conservative: Excision, embolization; surgery: Hysterectomy

US: Ultrasound; CT: Computed tomography; MRI: Magnetic resonance imaging; DIC: Disseminated intravascular coagulation.