Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Pyomyoma after Uterine Artery Embolization for Postpartum Hemorrhage Misdiagnosed as Uterine Necrosis

자궁동맥 색전술 후 발생한 자궁괴사로 오진된 농근종의 증례

  • Song, Hosuk (Department of Radiology, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Seo, Jung Wook (Department of Radiology, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Shin, Wonseon (Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine)
  • 송호석 (인제대학교 의과대학 일산백병원 영상의학과) ;
  • 서정욱 (인제대학교 의과대학 일산백병원 영상의학과) ;
  • 신원선 (계명대학교 의과대학 동산의료원 영상의학과)
  • Received : 2017.07.03
  • Accepted : 2017.09.19
  • Published : 2018.01.01
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Abstract

A 34-year-old female patient underwent uterine artery embolization (UAE) to control massive postpartum hemorrhage. The interventional radiologist was not informed of the patient's significant history of uterine myoma. Although no significant signs of complications or "red flags" were observed during the procedure, follow-up computed tomography performed four weeks later revealed evidence of a large, globe-like fluid collection with air bubbles in the uterus. The finding and pathology was initially diagnosed as uterine necrosis, which led not to interventional percutaneous drainage; instead, dilation and curettage with resectoscope was performed. The surgical and pathological diagnosis was "expulsion of pyomyoma in the uterine cavity." Awareness and precise knowledge of imaging findings of pyomyoma and uterine necrosis are important for early diagnosis and treatment of UAE-related complications.

34세 여자 환자의 출산 후 대량출혈에 대해서 자궁동맥 색전술을 시행하였다. 시술자는 환자의 자궁근종 병력에 대해 전달받지 못한 상태였다. 시술 중에 주목할만한 합병증이나 이상징후가 없었음에도 불구하고, 4주 후에 검사한 전산화단층 촬영에서 기포를 동반한, 구형 모양의 다량의 액체 저류가 자궁에서 확인되었다. 영상소견과 병리소견이 자궁괴사로 생각되었기 때문에 경피적 배액술은 시행되지 않았고, 대신에 자궁경을 사용한 자궁경부개대 및 소파술이 시행되었다. 수술 및 병리진단은 '자궁강 내로 배출된 농근종'이었다. 농근종 및 자궁괴사의 영상소견에 대한 정확한 감별진단은 자궁동맥 색 전술에 관계되어 발생한 합병증의 조기진단과 치료에 매우 중요하다.

Keywords

References

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