Enhanced Myometrial Vascularity: A Case Report and Diagnostic Insights

Introduction: Retained products of conception (RPOC) are a common cause of secondary postpartum haemorrhage. They pose both immediate and long-term health risks, such as abnormal bleeding, infection, and fertility issues. Ultrasound (USG) is the first line of imaging used to diagnose RPOC. Enhanced myometrial vascularity (EMV) is thought to result from placental site subinvolution due to remnants of conception products. In ultrasound imaging, endometrial vascularity (EMV) is characterized by a network of enlarged, twisted blood vessels that extend from the myometrium into the endometrium. On spectral Doppler, these vessels can exhibit varying degrees of elevated peak systolic velocities and increased diastolic flows. On ultrasound, EMV can appear ominous and is often mistaken for an arteriovenous malformation (AVM). Case presentation: A twenty-five-year-old woman presented with continuous bleeding per vagina following a surgical termination of a 10-week gestation. Transvaginal ultrasound showed a heterogeneous lesion in the endometrial cavity and multiple dilated vessels in the subjacent myometrium. Doppler imaging showed a high velocity and low resistance pattern suggestive of EMV. Ipsilateral parametrium showed enlarged uterine artery branches. Imaging differentials include RPOC with EMV and AVM. In this case, we discuss the imaging features of RPOC, EMV, and their differentials. We also discuss the implications of the imaging findings on treatment protocols. Conclusion: Treatment options for RPOC should be tailored to individual clinical circumstances and the grade of RPOC. Enhanced myometrial vascularity is a physiological phenomenon observed in the placental bed and should not be mistaken for AVM.