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1
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Giller DB, Hasanalieva UAK, Kulaeva MA, Filatova NA, Ustinov AV, Martel II. A case of simultaneous bilateral pulmonary resection for arteriovenous pulmonary malformation. Indian J Thorac Cardiovasc Surg 2025; 41:189-194. [PMID: 39822867 PMCID: PMC11732792 DOI: 10.1007/s12055-024-01757-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 01/19/2025] Open
Abstract
Pulmonary arteriovenous malformation (PAVM) is a congenital vascular pathology, which is caused by the presence of a direct connection between the branches of the artery and the veins of the lungs, and the discharge of unoxygenated blood into the arterial bed. Arteriovenous malformations are characterized by a wide variety of clinical manifestations and, in some cases, may be accompanied with severe circulatory disorders.
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Affiliation(s)
- Dmitry Borisovich Giller
- Sechenov First Moscow State Medical University, Moscow, Russia
- Moscow Regional Clinical Tuberculosis Dispensary, Moscow, Moscow Region Russian Federation
- Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Street, 8b2, Moscow, 119048 Russian Federation
| | - Ulker Azer kyzy Hasanalieva
- Sechenov First Moscow State Medical University, Moscow, Russia
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Rossolimo Street, 11, Building 2, Moscow, 119021 Russian Federation
| | - Margarita Andreevna Kulaeva
- Sechenov First Moscow State Medical University, Moscow, Russia
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Rossolimo Street, 11, Building 2, Moscow, 119021 Russian Federation
| | - Natalya Andreevna Filatova
- Sechenov First Moscow State Medical University, Moscow, Russia
- N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Rossolimo Street, 11, Building 2, Moscow, 119021 Russian Federation
| | - Alexander Vladimirovich Ustinov
- Moscow Regional Clinical Tuberculosis Dispensary, Moscow, Moscow Region Russian Federation
- Moscow Regional Clinical Antituberculosis Dispensary, Dubki Street, 7, Zdravnitsa Village, Mytishchi, Moscow Region 141132 Russian Federation
| | - Ivan Ivanovich Martel
- Sechenov First Moscow State Medical University, Moscow, Russia
- Moscow Regional Clinical Tuberculosis Dispensary, Moscow, Moscow Region Russian Federation
- Department of Phthisiopulmonology and Thoracic Surgery Named After M.I. Perelman, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Street, 8b2, Moscow, 119048 Russian Federation
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Shimohira M, Kawai T, Ohta K. An Update on Embolization for Pulmonary Arteriovenous Malformations. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:56-63. [PMID: 37485484 PMCID: PMC10359166 DOI: 10.22575/interventionalradiology.2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/26/2022] [Indexed: 07/25/2023]
Abstract
Pulmonary arteriovenous malformations are abnormal connections between a pulmonary artery and a pulmonary vein that can lead to ischemic stroke and brain abscess due to right-to-left shunting of blood. Embolization is currently considered the first treatment option for pulmonary arteriovenous malformations owing to its minimal invasiveness. This review updates the indications and techniques for the embolization of pulmonary arteriovenous malformations and determines the persistence of pulmonary arteriovenous malformations following embolization based on the most recent literature.
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Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
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Tabrizi NS, Stout PA, Cahill J, Sunesara IR, Chan P, Singh C, Fabian T, Shapeton AD, Musuku SR. Positive Bubble Study But No Evidence of Interatrial Defect in a Patient with Recurrent Cryptogenic Stroke. Turk J Anaesthesiol Reanim 2023; 51:271-274. [PMID: 37455534 DOI: 10.4274/tjar.2022.221106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) can be asymptomatic or result in a range of complications such as brain abscesses or cryptogenic emboli, which can contribute to morbidity and mortality if not diagnosed and treated in a timely manner. To date, there have been several reports of delayed diagnosis of PAVMs, which have been largely attributed to the misconception that PAVMs are too rare to be of clinical significance. Furthermore, because intracardiac shunting secondary to a patent foramen ovale (PFO) or atrial septal defect (ASD) also results in a positive saline contrast study with echocardiography, PAVM can be easily misdiagnosed as an intracardiac right-toleft shunt. However, there are unique echocardiographic features that differentiate between intracardiac shunting due to a PFO or ASD and extracardiac shunting such as in PAVM. This case details the course of a patient with recurrent cryptogenic strokes that was initially misattributed to a PFO and was only correctly diagnosed with multiple PAVMs after two failed attempts at PFO closure. This case serves as a reminder of an alternative etiology of right-to-left shunt and its presentation on imaging, which echocardiographers must be familiar with.
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Affiliation(s)
| | | | - Joseph Cahill
- Department of Cardiothoracic Surgery, Albany Medical Center, New York, United States
| | - Imran Ramzan Sunesara
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, United States
| | - Patrick Chan
- Department of Cardiothoracic Surgery, Albany Medical Center, New York, United States
| | - Chanderdeep Singh
- Department of Cardiothoracic Surgery, Albany Medical Center, New York, United States
| | - Thomas Fabian
- Department of Cardiothoracic Surgery, Albany Medical Center, New York, United States
| | - Alexander D Shapeton
- Department of Anaesthesia, Critical Care and Pain Medicine, Tufts University Faculty of Medicine, Boston, United States
| | - Sridhar Reddy Musuku
- Department of Anaesthesiology and Perioperative Medicine, Albany Medical Center, New York, United States
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4
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Nakai N, Ichiba T, Hata M, Okazaki Y. CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation. BMJ Case Rep 2023; 16:e253215. [PMID: 37130634 PMCID: PMC10163420 DOI: 10.1136/bcr-2022-253215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
Early diagnosis of basilar artery occlusion (BAO) based only on clinical findings is challenging. We present a fully recovered case of BAO caused by pulmonary arteriovenous malformation (PAVM) that was diagnosed early using a protocol for CT angiography (CTA) and promptly treated with endovascular therapy (EVT). A woman in her 50s complained of vertigo with normal level of consciousness (LOC). On arrival, her LOC decreased to a Grass Coma Scale score of 12, and we performed a CT chest-cerebral angiography protocol. Head CTA showed BAO, and an intravenous tissue plasminogen activator was administered, followed by EVT. Chest contrast-enhanced CT showed PAVM in segment 10 of the left lung, which was treated with coil embolisation. For patients with a complaint of vertigo, BAO should be suspected, even if they have an initially normal LOC. A CT chest-cerebral angiography protocol is useful for prompt diagnosis and treatment of BAO and can reveal undetermined causes.
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Affiliation(s)
- Natsumi Nakai
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Masako Hata
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Yuji Okazaki
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
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Zheng J, Wu QY, Zeng X, Zhang DF. Transient ischemic attack induced by pulmonary arteriovenous fistula in a child: A case report. World J Clin Cases 2023; 11:2009-2014. [PMID: 36998959 PMCID: PMC10044967 DOI: 10.12998/wjcc.v11.i9.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism. Pulmonary arteriovenous fistula (PAVF) is a rare potential cause of cerebral ischemic stroke, and cerebral ischemic stroke induced by PAVF in children is rare.
CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack (TIA) in a 13-year-old boy. The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.
CONCLUSION TIA induced by PAVF in children is rare, lacks typical clinical manifestations, and should not be ignored.
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Affiliation(s)
- Jun Zheng
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Qi-Yue Wu
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Xia Zeng
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Du-Fei Zhang
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
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Ma X, Li LL, Yu D, Jie B, Jiang S. Management of pulmonary arteriovenous malformations involves additional factors aside from the diameter of feeding arteries: a 3-year case-case retrospective analysis. Respir Res 2022; 23:107. [PMID: 35501913 PMCID: PMC9063074 DOI: 10.1186/s12931-022-02030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pulmonary arteriovenous malformations (PAVMs) are rare but cause various manifestations. Although the diameter of feeding arteries has been linked to treatment decisions, relationships among the characteristics of PAVMs, clinical symptoms, and treatment effect remain unclear. The present study was performed to investigate how collective characteristics of PAVMs relate to clinical symptoms and to provide proper treatment recommendations for patients with PAVMs.
Methods
We retrospectively analysed 838,447 patients’ radiographic data and medical records from January 2018 to December 2020. Patients were included if a PAVM was radiographically detected for the first time in our hospital. Ordered multivariable logistic regression and hierarchical multiple regression were performed to analyse the relationships between characteristics of PAVMs and various clinical symptoms. We investigated the management of PAVMs in four tertiary university hospitals.
Results
Detection rate of PAVMs was 0.025% (207/838,447), and 37.6% of patients (78/207) also had hereditary haemorrhagic telangiectasia. Eight patients were diagnosed with bilateral diffuse PAVMs. Two hundred thirty-six lesions were detected in 199 patients, and the mean diameter of the feeding artery was 4.13 ± 1.92 mm. Most PAVMs were the simple type and located in the peripheral pulmonary area. In total, 34.3% of patients (71/207) were symptom-free; remaining patients showed various manifestations, and respiratory symptoms were most common (dyspnoea on exertion, 47.8%). The diameter of the feeding artery and the type and the number of PAVMs were correlated with hypoxaemia (P < 0.001, P < 0.001, and P = 0.037, respectively). The collective characteristics of PAVMs were not related to the severity of central nervous system symptoms (largest diameter of feeding artery, P = 0.8; largest diameter of sac, P = 0.42; number of PAVMs, P = 0.35; type of PAVMs, P = 0.99). Various symptoms were greatly relieved after treatment. The hospital investigation showed that management of PAVMs was not generally appreciated in clinical practice.
Conclusions
Our study revealed a low detection rate of PAVMs and a low degree of association with hereditary haemorrhagic telangiectasia in the general population. Considering the connection between collective characteristics of PAVMs and various clinical symptoms, clinicians should consider the type and number of PAVMs, the largest diameter of the feeding artery, and clinical symptoms when managing patients with PAVMs.
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Sadras I, Mei-Zahav M, Breuer O. Persistent hypoxaemia and a headache in a previously healthy 11-year-old girl. Thorax 2022; 77:631-632. [PMID: 35354648 DOI: 10.1136/thoraxjnl-2022-218723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ido Sadras
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Breuer
- Pediatric Pulmonology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Luís H, Machado B, Barros C, Gomes M. Pulmonary arteriovenous malformation as a cause of ischaemic stroke in the elderly. BMJ Case Rep 2021; 14:e245529. [PMID: 34598969 PMCID: PMC8488706 DOI: 10.1136/bcr-2021-245529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
Pulmonary arteriovenous malformation (PAVM) is well recognised as a cause of paradoxical brain embolism. The authors report the case of an older woman with a medical history of arterial hypertension who was found unconscious and was discovered to have pulmonary thromboembolism and ischaemic stroke related to a PAVM.
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Affiliation(s)
- Helena Luís
- Internal Medicine, SESARAM, Funchal, Portugal
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9
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Ma X, Jie B, Yu D, Li LL, Jiang S. Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years' retrospective study. BMC Pulm Med 2021; 21:230. [PMID: 34256765 PMCID: PMC8276419 DOI: 10.1186/s12890-021-01604-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.
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Affiliation(s)
- Xu Ma
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Bing Jie
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Dong Yu
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Ling-Ling Li
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China
| | - Sen Jiang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai, 200433, China.
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Rens J, Van Thielen T, Derweduwen A, Goedseels K, Hes R, de Jong L. Screening in cryptogenic brain abscess: Do not forget pulmonary arteriovenous malformations. Surg Neurol Int 2021; 12:188. [PMID: 34084616 PMCID: PMC8168651 DOI: 10.25259/sni_51_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Brain abscess usually occurs secondary to trauma, through contiguous spread (e.g.; dental infections, [paranasal] sinusitis, otitis, and mastoiditis), after intracranial neurosurgical procedures, or through hematogenous spread in case of an arteriovenous (AV) shunt, for example; atrial septum defect. Although uncommon, another possible cause of AV shunt which can facilitate brain abscess is a pulmonary arteriovenous malformation (PAVM). We report a case of brain abscess secondary to a solitary PAVM and review the literature. Case Description: A 74-year-old male patient presented with headaches, fatigue, low-grade fever, and homonymous hemianopsia. He was diagnosed with a brain abscess in the left occipital lobe. A chest computed tomography (CT) with intravenous (IV) contrast was performed because of fever and respiratory insufficiency in a period where screening for COVID-19 in suspected patients was important. A solitary PAVM of the left lung was diagnosed. Initial stereotactic burr hole drainage of the abscess was insufficient and resection of the abscess was deemed necessary. Routine workup did not reveal any additional pathology apart from the PAVM. After treatment of the cerebral abscess, the PAVM was treated with embolization using an endovascular plug. Conclusion: It is recommended to screen for PAVM by chest CT with IV contrast in patients with brain abscess when no obvious source of infection can be identified.
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Affiliation(s)
- Jasmien Rens
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | | | | | - Koen Goedseels
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | - Robert Hes
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | - Lars de Jong
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
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Li R, Zhou Y, Kang S, Kong F, Guan L, Zhao Y, Yin X. Declarations: management of a pulmonary arteriovenous fistulae by uniportal video-assisted thoracoscopic surgery: a case report. BMC Surg 2021; 21:101. [PMID: 33622276 PMCID: PMC7903596 DOI: 10.1186/s12893-021-01103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A pulmonary arteriovenous fistula (PAVF) is a rare condition that is associated with pulmonary arteriovenous malformation (PAVM). Few reports have described managing PAVMs using uniportal video-assisted thoracoscopic surgery (VATS). CASE PRESENTATION A 13-year-old child with PAVF in the left inferior pulmonary artery was treated by uniportal VATS with left lower lobectomy. After surgery, hemoptysis did not recur and there were no postoperative complications. Six months after the operation, postoperative review of computerized tomography showed no recrudescence of PAVF. CONCLUSIONS PAVF is a rare case that should be diagnosed and treated early. 3D- computerized tomography (CT) reconstruction is useful for diagnosis and preoperative assessment. The case shows that PAVF can be managed with uniportal VATS.
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Affiliation(s)
- R Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Y Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - S Kang
- Department of Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - F Kong
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - L Guan
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Y Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - X Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
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Belopasova AV, Dobrynina LA, Kalashnikova LA, Chechetkin AO, Karshieva AR, Abugov SA, Mardanyan GV, Puretsky MB, Shteklein AB. [Pulmonary arteriovenous shunt - a rare cause of recurrent stroke due to paradoxical embolism]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:107-113. [PMID: 33081455 DOI: 10.17116/jnevro2020120091107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.
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Affiliation(s)
| | | | | | | | | | - S A Abugov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Mardanyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - M B Puretsky
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A B Shteklein
- Peoples' Friendship University of Russia, Moscow, Russia
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13
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Kang HC, Martins Pereira MA, Silva LNL, Oliveira LC, Márvila IS. Hereditary Hemorrhagic Telangiectasia in a Sickle Cell Trait Patient: A Report of a Rare Case with Use of Nuclear Medicine, and a Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923355. [PMID: 32614805 PMCID: PMC7347035 DOI: 10.12659/ajcr.923355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient: Female, 49-year-old Final Diagnosis: Hereditary haemorrhagic telangiectasia Symptoms: Anemia • dyspnea • epistaxis • lipothymia • melena • weakness Medication:— Clinical Procedure: Electrofulguration Specialty: Gastroenterology and Hepatology • Genetics • Radiology
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Affiliation(s)
- Hye Chung Kang
- Department of Pathology, Fluminense Federal University, Niterói, RJ, Brazil
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14
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Pulmonary arteriovenous malformations: what the interventional radiologist needs to know. Radiol Med 2019; 124:973-988. [PMID: 31209790 DOI: 10.1007/s11547-019-01051-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
Pulmonary arteriovenous malformations (PAVMs) or fistulas are rare direct pathological connections between pulmonary arterial and venous circulation. Most of PAVMs are congenital and closely associated with hereditary hemorrhagic telangiectasia, but acquired PAVMs have also been described in the literature. Diagnosis of PAVMs is a priority for clinicians, in order to prevent potentially fatal events such as cerebrovascular stroke, systemic septic embolization, hemoptysis and hemothorax. In this scenario, the radiologist plays a key role in both diagnostic and therapeutic workups of PAVMs: Chest X-ray, computed tomography and magnetic resonance are effective tools for PAVMs identification and confirmation of the suspected diagnosis. Furthermore, imaging modalities provide most of the elements for PAVMs classification according to their angioarchitecture (simple and complex) and help the clinicians in establishing which lesion requires prompt treatment and which one will benefit of imaging follow-up alone. Endovascular management of PAVMs has grown up as the first-line treatment in respect of surgery during last decades, showing lower risk of intra- and post-procedural complications and offering a wide number of treatment options and materials, ensuring effective management in virtually any clinical situation; interventional treatment aims to exclude PAVMs from pulmonary circulation, and specific technique and embolic agents should be selected according to pre-treatment imaging, in order to obtain the best procedural outcome. This paper proposes a review of the clinical and radiological features that a radiologist needs to know for PAVMs diagnosis and proper management, also showing an overview of the most common endovascular treatment strategies and embolization materials.
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15
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Thrombolysis in Ischemic Stroke Patients with Isolate Pulmonary Arteriovenous Malformations. J Stroke Cerebrovasc Dis 2019; 28:e68-e70. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/23/2019] [Accepted: 03/01/2019] [Indexed: 11/22/2022] Open
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16
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Fan C, Cheng J, Wu S, Tang S, Chen W, Yang J. Pulmonary Arteriovenous Malformation Detected by Three-dimensional Computed Tomographic Angiography. Heart Lung Circ 2017; 26:e59-e61. [PMID: 28400192 DOI: 10.1016/j.hlc.2017.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 12/23/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Chengming Fan
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Cheng
- Department of the Cardiothoracic Surgery, Xiangtan Center Hospital, Xiangtan, China
| | - Sijie Wu
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shiyuan Tang
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinfu Yang
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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