A Rare Case of Uterine Artery Pseudoaneurysm After Hysteroscopic Management of Trophoblastic Disease.

INTRODUCTION

Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening condition, most commonly associated with childbirth and less frequently with intrauterine procedures such as dilatation and curettage or hysteroscopy. Its incidence is estimated at 3-6 per 1000 deliveries, whereas occurrence in the context of gestational trophoblastic disease (GTD) is extremely uncommon. UAP may remain asymptomatic before presenting as sudden vaginal hemorrhage days to weeks after uterine intervention. Prompt recognition and timely imaging are essential for effective management. Computed tomography (CT) angiography is considered the gold standard, whereas Doppler ultrasound and magnetic resonance imaging (MRI) are valuable alternatives. Uterine artery embolization is the preferred treatment due to its high success rate and fertility-preserving potential.

CASE PRESENTATION: We report an exceptionally rare case of UAP developing 5 weeks after hysteroscopic removal of retained products of conception in the context of GTD. Power Doppler ultrasonography demonstrated a hypervascular lesion with a characteristic swirling flow pattern, confirmed by contrast-enhanced CT. The patient underwent successful selective uterine artery embolization, resulting in complete symptom resolution. Over 5 years of follow-up, she remained recurrence-free, with regular menstruation and a subsequent full-term delivery, indicating preserved reproductive function.

DISCUSSION: This case highlights the importance of considering UAP in delayed posthysteroscopic hemorrhage, particularly in GTD. Multimodal imaging is essential for accurate diagnosis and differentiation from other vascular lesions. Selective uterine artery embolization is a safe, effective, and fertility-preserving treatment with favorable long-term outcomes, including successful pregnancy.