Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade

Objective Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon...

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Bibliographic Details
Published in:Journal of international medical research 2020-04, Vol.48 (4), p.300060519893166-300060519893166
Main Authors: Takeda, Jun, Makino, Shintaro, Hirai, Chihiro, Shimanuki, Yota, Inagaki, Tetsunori, Itakura, Atsuo, Takeda, Satoru
Format: Article
Language:English
Subjects:
Aneurysm, False - diagnostic imaging
Aneurysm, False - therapy
Female
Hemorrhage
Humans
Japan
Postpartum period
Pregnancy
Pseudoaneurysm
Retrospective Clinical Research Report
Retrospective Studies
Tomography
Ultrasonic imaging
Ultrasonography
Uterine Artery - diagnostic imaging
Uterine Balloon Tamponade
Uterus
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Summary:Objective Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon tamponade. Methods Cases of ruptured UAP diagnosed at a teaching university hospital from January 2015 to December 2017 were retrospectively analyzed. UAP was diagnosed using color Doppler ultrasonography. Extravasation was identified using computed tomography and double checked using CEU with an intravenously administered contrast agent (Sonazoid; Daiichi Sankyo Company, Ltd., Tokyo, Japan) and an ultrasound instrument (HI VISION Preirus; Hitachi Aloka Medical, Ltd., Tokyo, Japan). A balloon was then inserted into the uterine cavity and inflated at the point of bleeding until extravasation ceased. Results Three patients exhibited ruptured UAP during the study period. Bleeding points were successfully identified using CEU in all cases, and hemostasis was achieved using uterine balloon tamponade. Obliteration of UAP was confirmed using magnetic resonance imaging, and no patients developed recurrent UAP or any complications. Conclusion CEU can be used at the bedside to promptly diagnose ruptured UAP. Moreover, it precisely facilitates balloon compression at the point of bleeding.
ISSN:0300-0605
1473-2300
DOI:10.1177/0300060519893166