Figure 6c. AVM combined with a pseudoaneurysm in a 24-year-old woman. The patient had intermittent vaginal bleeding after D&C for a therapeutic abortion 50 days earlier. The serum ß-HCG test was negative at presentation. (a) Transverse gray-scale US image shows subtle myometrial inhomogeneity (arrows) in the left lateral wall of the uterus and an anechoic sac (arrowhead) in the endometrium. (b) Transverse color Doppler US image shows a tangle of tortuous vessels (arrows) and a blood-filled cystic structure (arrowhead) in the corresponding area. (c) Transverse duplex Doppler US image shows fast arterial flow with low resistance in the myometrium (PSV, 67 cm/sec; RI, 0.43). (d) Left internal iliac angiogram obtained during the late arterial phase shows a markedly opacified vascular tangle (arrows) and a pseudoaneurysm (black arrowheads) supplied by the left uterine artery. Early draining veins (white arrowhead) are seen. After embolization with absorbable gelatin sponge pledgets, no bleeding recurred.