Cesarean scar pregnancy associated with uterine artery pseudoaneurysm: a case report

Cesarean scar pregnancy (CSP) and uterine artery pseudoaneurysms (UAPs) are associated with massive uterine hemorrhage and mortality. As a result of their low prevalence, the occurrence of CSP and a UAP in the same patient is extremely rare. The authors describe a patient who was initially misdiagnosed with trophoblastic disease by ultrasonography. The lesion had a blood-rich area of 75 x 65 x 61 mm on ultrasonography. Pelvic angiography revealed a UAP in the right side of the uterus. The patient underwent uterine artery embolization (UAE) immediately after the correct diagnosis was confirmed. Curettage was undertaken under ultrasound guidance one week postoperatively. Histopathological examination of the resected tissue revealed degenerative chorionic villi and trophoblasts with blood clots. Serum levels of beta-human chorionic gonadotropin (p-hCG) and uterine ultrasound recovered to normal levels two weeks and three months later, respectively.