MRI Findings After Post-abortion Hemorrhage: What if It Were a Uterine Arteriovenous Malformation?

Uterine arteriovenous malformations (AVMs) and markedly enhanced myometrial vascularity are uncommon but potentially life-threatening causes of abnormal uterine bleeding, particularly after pregnancy-related events or uterine instrumentation. Their recognition is clinically important because repeat blind uterine evacuation may worsen hemorrhage when a high-flow vascular lesion is present. We report the case of a 35-year-old woman, gravida 5 para 5, who presented to the emergency department 10 days after abortion and uterine curettage with recurrent severe metrorrhagia, hemorrhagic shock, and severe anemia with a hemoglobin level of 7 g/dL requiring transfusion. A pelvic MRI was performed for further evaluation. MRI demonstrated heterogeneous fundal intrauterine material compatible with retained products of conception in the appropriate post-abortion context. This material was closely related to an adjacent abnormal fundal intramyometrial vascular area. Dynamic gadolinium-enhanced sequences showed early enhancement of prominent serpiginous vascular structures within the fundal myometrium and adjacent periuterine vascular channels, raising concern for an acquired uterine AVM-like lesion or markedly enhanced myometrial vascularity associated with retained products of conception. Uterine artery embolization was proposed as a fertility-preserving therapeutic option; however, angiographic confirmation, whether this procedure was performed, and post-treatment follow-up were not documented in the available medical record. This case highlights the value of MRI in severe post-abortion bleeding by clarifying the relationship between retained intrauterine tissue and abnormal myometrial vascularity, while emphasizing the need for cautious terminology when angiographic confirmation is unavailable.