A patient with symptomatic uterine fibroids (menorrhagia, bulk symptoms) undergoes uterine artery embolisation (UAE). Post-procedure MRI at 3 months shows all fibroids are non-enhancing (infarcted). However, the patient develops fever, malodorous vaginal discharge, and uterine tenderness at 6 weeks. The most serious complication being considered is:

• A Ovarian failure from non-target embolisation of ovarian arteries
• B Pulmonary embolism from paradoxical embolisation of microspheres
• C Fibroid recurrence due to incomplete embolisation
• D Transcervical expulsion of an infected/infarcting fibroid with septic endometritis ✓

Explanation

Transcervical fibroid expulsion occurs in 2–5% of UAE cases, particularly with submucosal fibroids — as the infarcted fibroid liquefies and seeks the path of least resistance, it may pass transcervically, causing fever, discharge, pelvic pain, and septic endometritis. This can be managed conservatively or with hysteroscopic resection but requires urgent evaluation to exclude septic complications. Ovarian failure is a real but less acute risk. Pulmonary embolism from microspheres is theoretical and extremely rare.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.