Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature
<p>Abstract</p> <p>Introduction</p> <p>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...
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| Format: | Article |
| Language: | English |
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BMC
2012-11-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://www.jmedicalcasereports.com/content/6/1/397 |
| _version_ | 1818036841927933952 |
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| author | Bhavsar Tapan Wurzel John Duker Nahum |
| author_facet | Bhavsar Tapan Wurzel John Duker Nahum |
| author_sort | Bhavsar Tapan |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Introduction</p> <p>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.</p> <p>Case presentation</p> <p>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 <it>Staphylococcus aureus</it> 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.</p> <p>Conclusion</p> <p>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.</p> |
| first_indexed | 2024-12-10T07:17:22Z |
| format | Article |
| id | doaj.art-e920f3ae8bdd49168ce654d0e646f267 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-10T07:17:22Z |
| publishDate | 2012-11-01 |
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| spelling | doaj.art-e920f3ae8bdd49168ce654d0e646f2672022-12-22T01:57:54ZengBMCJournal of Medical Case Reports1752-19472012-11-016139710.1186/1752-1947-6-397Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literatureBhavsar TapanWurzel JohnDuker Nahum<p>Abstract</p> <p>Introduction</p> <p>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.</p> <p>Case presentation</p> <p>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 <it>Staphylococcus aureus</it> 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.</p> <p>Conclusion</p> <p>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.</p>http://www.jmedicalcasereports.com/content/6/1/397HemangiomaCavernousMyometriumThrombosisPulmonary emboli |
| spellingShingle | Bhavsar Tapan Wurzel John Duker Nahum Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature Journal of Medical Case Reports Hemangioma Cavernous Myometrium Thrombosis Pulmonary emboli |
| title | Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature |
| title_full | Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature |
| title_fullStr | Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature |
| title_full_unstemmed | Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature |
| title_short | Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature |
| title_sort | myometrial cavernous hemangioma with pulmonary thromboembolism in a post partum woman a case report and review of the literature |
| topic | Hemangioma Cavernous Myometrium Thrombosis Pulmonary emboli |
| url | http://www.jmedicalcasereports.com/content/6/1/397 |
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