A 39-year-old woman with menorrhagia of 7 years' duration was found to have a capillary hemangioma of the endometrium. Initial diagnosis by curettage was considered questionable but was later confirmed at hysterectomy. A thorough search and review of the literature was performed.
"Such cavernous hemangiomas are associated with numerous obstetric and gynecological complications, ranging from intermenstrual spotting, menometrorrhagia and infertility, to maternal and/or fetal demise, resulting from pronounced bleeding of the gravid uterus [5-8]. Occasionally, they may present as life-threatening hemorrhage, requiring immediate surgical intervention including hysterectomy . "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Cavernous hemangiomas of the uterus are rare benign vascular lesions. Nine cases of diffuse cavernous hemangioma of the gravid uterus have been reported, most of which diffusely involved the myometrium. These vascular malformations are clinically significant, and may cause pronounced bleeding resulting in maternal or fetal demise. Thrombosis of cavernous hemangiomas of the uterus has been previously reported. We here report the first case in which a thrombosed cavernous hemangioma of the myometrium resulted in a fatal pulmonary embolism in a post-partum woman.
A 25-year-old obese African-American woman who had one pregnancy and was delivered of twins by cesarean section was admitted 1 week after the successful delivery. The 12-day clinical course included ventilator-dependent respiratory failure, systemic hypertension, methicillin-resistant Staphylococcus aureus in the sputum, leukocytosis and asystole. A transabdominal ultrasound examination showed heterogeneous thickened and irregular products in the endometrial canal. The laboratory values were relevant for an increased prothrombin time, activated partial thromboplastin time, ferritin and a decrease in hemoglobin. The clinical cause of death was cited as acute respiratory distress syndrome. At autopsy, a 400g spongy, hemorrhagic uterus with multiple cystic spaces measuring approximately 0.5 × 0.4cm filled with thrombi within the myometrium was identified. Immunohistological examination with a CD31 stain for vascular endothelium associated antigen confirmed several endothelium-lined vessels, some of which contained thrombi. These histological features were consistent with cavernous hemangioma of the myometrium. A histological examination of the lungs revealed multiple fresh thromboemboli in small- and medium-sized pulmonary arteries in the right upper and lower lobes without organization, but with adjacent areas of fresh hemorrhagic infarction.
This case underscores the importance of a high index of suspicion in a pregnant or post-partum woman presenting with respiratory symptoms. Thrombosis of the cavernous hemangiomas of the gravid or post-partum uterus is a rare entity. This case is of interest because it indicates that this condition can be fatally complicated by embolization of the thrombi in the cavernous myometrial hemangiomas. Although delivery by conservative methods, as well as cesarean section, is possible without resorting to hysterectomy, occasionally, the consequences could be fatal as in this case.
Journal of Medical Case Reports 11/2012; 6(1):397. DOI:10.1186/1752-1947-6-397
[Show abstract][Hide abstract] ABSTRACT: Diffuse cavernous hemangioma of the uterus in pregnant woman is an extremely rare condition. A total of eight cases have been described in the literature till date. The antenatal diagnosis as well as management requires considerable skill. Although it is a benign condition but it can have serious consequences for the mother as well as the baby.
Here we describe an interesting case of diffuse cavernous hemangioma of the uterus in a 21-year-old G3, P2-0-0 pregnant woman, who underwent hysterectomy for uncontrollable bleeding during third cesarean section. The diagnosis of diffuse cavernous hemangioma was made only on histopathological examination of the hysterectomy specimen.
Diffuse hemangioma of the uterus in a pregnant woman is a serious condition, which may not be detected early during the pregnancy. This can result in uncontrolled bleeding especially during operative delivery and may require hysterectomy.
Archives of Gynecology 10/2008; 279(4):603-5. DOI:10.1007/s00404-008-0764-7 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cavernous hemangiomas of the uterus are extremely rare, benign lesions. A survey of the current literature identified fewer than 50 cases of hemangioma of the uterus.
We report a case of cavernous hemangioma of the uterus in a 27-year-old Malay, para 1 woman who presented at our hospital with torrential vaginal bleeding having been transferred by land ambulance from a district hospital 30 minutes away. 11 weeks previously she had an urgent cesarean section at our hospital. She had to undergo a hysterectomy to control her bleeding after other measures were unsuccessful. A histopathological report confirmed a diffuse ramifying hemangioma of the cervix and uterus with left hematosalpinx.
Most ramifying hemangioma lesions are asymptomatic and are found incidentally, but sometimes they may cause abnormal vaginal bleeding and hence should be included in the differential diagnosis of patients with vaginal bleeding. Hysterectomy is the primary mode of treatment in most symptomatic cases.
Journal of Medical Case Reports 05/2010; 4(1):136. DOI:10.1186/1752-1947-4-136
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