2272 Overdiagnosis of Uterine Arteriovenous Malformation in Radiology Reports on Pelvic Ultrasound in an Inner-City Teaching Hospital

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Conference Proceeding

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J Minim Invasive Gynecol


Study Objective: Uterine arteriovenous malformations (AVMs) are rare occurrences, diagnosed radiologically, and often associated with bleeding and a history of uterine instrumentation. The objective of our study was to assess our health system's rate of overdiagnosis of uterine AVM on pelvic ultrasound. Design: A retrospective chart review was performed from 2008 to present including patients who had the word “AVM” mentioned in their pelvic ultrasound reports. These reports were reviewed, and patients were included in the study if the ultrasound report had language that either stated that uterine AVM could not be excluded from the differential diagnosis for bleeding or that AVM was likely. Patients were excluded if the report stated that based on the US findings AVM was unlikely or virtually ruled out. Patients were deemed to have a true AVM if confirmed by subsequent MRI or angiography. Setting: Data was extracted from Henry Ford Health System's electronic medical record extending from 2008 to present. The patient population sampled was from Southeast Michigan. Patients or Participants: Women who presented with vaginal bleeding and underwent pelvic ultrasound. Interventions: None. Measurements and Main Results: 120 charts were reviewed that met our inclusion criteria. Of these, 19 (16%) were confirmed uterine AVM by either angiogram or MRI. An additional 21 (17%) had suspected AVMs but did not undergo confirmatory diagnosis. 80 (66%) had uterine AVM suggested as a diagnosis on their ultrasound report but were ultimately diagnosed with an alternative pathology, either clinically or with imaging. Our data show that 60% of AVM diagnoses on ultrasound reports were likely an overdiagnosis. 43 (35%) of these patients were treated for retained products of conception either surgically or medically. Conclusion: Overdiagnosis is clinically important not only due to cost implications, but because in the setting of true uterine AVM, surgical treatment for retained products via D&C is contraindicated.





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