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Case Reports in Obstetrics and Gynecology
Volume 2016 (2016), Article ID 6353471, 4 pages
http://dx.doi.org/10.1155/2016/6353471
Case Report

Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

1Division of Interventional Radiology, Department of Radiology, Notre-Dame Hospital, University of Montreal Hospital Centers (CHUM), 1560 Sherbrooke East, Montreal, QC, Canada H2L 4M1
2Radiology Department, King Khalid University Hospital, King Saud University, Riyadh 12372, Saudi Arabia

Received 25 January 2016; Revised 27 May 2016; Accepted 31 May 2016

Academic Editor: Matthew K. Hoffman

Copyright © 2016 Husain Alturkistani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma.