EP21.40: An incidental finding of vascular cystic lesion (possible arteriovenous malformation) in gestational sac

A 33-year-old female, para 3+2 (2 spontaneous vaginal deliveries, 1 Caesarean section, 1 dilatation and curettage), presented with a history of missed miscarriage at 9 weeks. She was admitted for medical management of miscarriage. There was an incidental finding of a cystic structure in gestational sac with active blood flow. There was also a large left ovarian cyst about 12x13cm in size. Pelvic ultrasounds and MRIs were performed to assess possible AVM (Arteriovenous malformation) and ovarian cyst. Pelvic angiogram showed blush in uterine area without venous return (excluding arteriovenous malformation). Bilateral uterine artery embolisation was performed for emergent gynecological bleeding. Subsequent pelvic ultrasounds and MRIs were performed to follow up. It showed a decrease in the size of the AVM and a stable large left ovarian cyst. AVM in pregnancy pose a dilemma in diagnosis and management. The management of uterine arteriovenous malformations (AVMs) in pregnancy depends on several factors, including the severity of symptoms, the size and location of the AVM and gestational age. Generally, the management options for AVMs in pregnancy include conservative, medical, radiological and surgical. In our case, as fertility preservation was very important factor for the patient, hence interventional radiology was chosen as the preferred management. This case highlights the challenges in diagnosing and managing vascular intrauterine lesion, and the importance of multimodal imaging and interventional radiology in their management (see figure 1). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.