子宫动静脉瘘临床误诊及超声造影特征分析OA

Objective To investigate the causes of misdiagnosis of uterine arteriovenous fistula(UAVF)and the imaging characteristics of contrast-enhanced ultrasound(CEUS).Methods A retrospective analysis was conducted on the clinical data of 18 patients with UAVF who were initially misdiagnosed with other diseases and admitted between January 2023 and June 2025.Results The main clinical manifestations of the 18 patients were abnormal uterine bleeding(n=16)or sudden lower abdominal pain(n=2).Nine patients were initially misdiagnosed as gestational trophoblastic disease due to ultrasound findings of abundant blood flow signals in the uterine myometrium characterized by a high-velocity,low-resistance arterial spectrum;the diagnosis was confirmed after exclusion via serum β-hCG testing and pathological examination.Five patients were misdiagnosed as degeneration of uterine fibroids or malignancy due to unclear lesion boundaries,disorganized echogenicity,and accompanying pelvic fluid;diagnosis was clarified by CEUS and magnetic resonance imaging(MRI).Three patients with a history of cesarean section were misdiagnosed as uterine incision diverticulum with hemorrhage based on ultrasound findings of heterogeneous myometrial echogenicity in the lower uterine segment;the presence of a fistula was confirmed by CEUS.One patient presenting with sudden massive bleeding and shock was misdiagnosed in the Emergency Department as dysfunctional uterine bleeding,and later diagnosed via interventional angiography during the procedure.All patients underwent conventional ultrasound and CEUS.Conventional color Doppler ultrasound mainly showed anechoic or hypoechoic areas within the uterine myometrium with"honeycomb-like"or"tubular"blood flow signals;pulsed-wave Doppler revealed a high-velocity,low-resistance arterial-like spectrum.CEUS features included rapid filling of the contrast agent at the fistula orifice during the arterial phase,presenting as a"jet-like"or"lake-like"aggregation,earlier than the surrounding myometrium,with early display of the fistula and draining veins,and rapid washout of the contrast agent.The misdiagnosis period ranged from 7 dto 5 months.After definitive diagnosis,8 patients underwent vascular interventional embolization(UAE);among the 8 patients receiving pharmacotherapy,2 were subsequently switched to UAE,and 2 patients with mild conditions received conservative treatment.After 3-18 months of follow-up,symptoms had completely disappeared in 16 patients,with follow-up ultrasound showing significantly reduced or absent blood flow signals in the lesions;symptoms were significantly improved in the remaining 2 patients.All patients who underwent interventional therapy successfully preserved the uterus,and no severe complications occurred during follow-up.Conclusion The clinical manifestations and conventional ultrasound features of UAVF are easily confused with pregnancy-related diseases and uterine tumors,leading to misdiagnosis.CEUS can clearly demonstrate the hemodynamic characteristics of the fistula orifice.Combining clinical history and timely interventional examinations also contributes to improving diagnostic accuracy.