Pseudoaneurysm of the uterine artery after Cesarean delivery - Sonographic diagnosis and treatment

A pseudoaneurysm is an extraluminal. collection of blood with turbulent flow that communicates with flowing arterial blood through a defect in the arterial wall. The development of an arterial pseudoaneurysm is a rare but reported complication of pelvic surgery or after vascular trauma. Hormonal and hemodynamic changes are considered the origins of this complication in pregnancy or puerperium. After hematoma formation there is central liquefaction of the hematoma, which leaves a cavity in which there is turbulent blood flow from a persistent communication between the parent artery and the hematoma. The absence of a 3-layer arterial wall lining the pseudoaneurysm differentiates it from a true aneurysm, which is less common than a pseudoaneurysm.(1-4) There is also a reported case of a pseudoaneurysm of the uterine artery associated with a leiomyoma without prior surgery or pregnancy.(5) Typically the lesions are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage.(4) A pseudoaneurysm may be asymptomatic, may thrombose, or may lead to distal. painful embolization. The risk of rupture is proportional to the size and intramural pressure. Diagnosis is usually based on both Doppler sonography and arteriography.(2,5) We report a case of a uterine artery pseudoaneurysm diagnosed 4 weeks after cesarean delivered which ruptured before planned hysterectomy.