CASES 735-736-737: ENHANCED MYOMETRIAL VASCULARITY [EMV], Dr PHAN THANH HẢI, Dr DƯƠNG ĐĂNG NGỌC PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

3 cases of EMV post partum were discovered by Doppler ultrasound and were managed successfully in ceasing the menorrhagia by curettage.

Case 01:

After 3 months delivery without menorrhagia and beta HCG negative but EMV on transvaginal sonography (TVS). Doubtful placental retention.

Case 02:

Menorrhagia for 20 days after miscarriage, blood beta HCG = 19.25mUI/mL, TVS detected EMV.

Case 03: 

Menorrhagia in small amount for each batch every 2-3 days with  beta HCG highly rising = 66.975  mUI/mL, TVS detected uterine bloody retention, noted placental retention and EMV.

Microscopic specimen was placental villous structure.

BetaHCG = 2.1mUI/mL after curettage procedure.

REFERENCE

EMV Ultrasound findings ( from Radiopaeda)

It is impossible to distinguish enhanced myometrial vascularity from a true arteriovenous malformation on ultrasound 5. 

On greyscale ultrasound, there are anechoic, tortuous, tubular structures within the myometrium that may involve the endometrium. Echogenic intrauterine material in keeping with concurrent retained products of conception is commonly seen.

On color Doppler ultrasound, there is a mosaic turbulent pattern with multiple flow reversals. This demonstrates low impedance flow with a high peak systolic velocity (PSV) ≥20 cm/s and low arterial waveform pulsatility. It should be noted that while some authors consider a PSV >60 cm/s to be high risk 4,9,10, studies have shown that higher PSV values do not necessarily confer a greater hemorrhagic risk 1.