Twenty-four hours after uterine artery embolization for symptomatic fibroids, a 42-year-old woman reports fever up to 38 degrees Celsius, pelvic pain, nausea, and a mild leukocytosis. She is haemodynamically stable and the uterus is not tender beyond expected cramping. The most likely diagnosis is:

• A Pyometra requiring emergency hysterectomy
• B Post-embolization syndrome ✓
• C Uterine artery pseudoaneurysm rupture
• D Pulmonary embolism

Explanation

Post-embolization syndrome is a self-limiting constellation of fever, pain, nausea, vomiting, and leukocytosis occurring within days of any solid organ embolization, including UAE. It reflects tissue ischaemia and inflammatory mediator release and is managed supportively with analgesia and antiemetics. Emergency hysterectomy is reserved for septic infarction with a toxic picture, and pseudoaneurysm presents with bleeding, not this systemic inflammatory response.

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

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Written and medically reviewed by the StethoPrep medical team.