Pulmonary arteriovenous malformation treated by lobectomy (original) (raw)
Related papers
Journal of International Medical Research, 2005
Pulmonary arteriovenous malformations (PAVMs) are rare anomalies. The degree of right-to-left shunting, which can lead to cyanosis and paradoxical embolism causing neurological complications, determines the prognosis. We report two cases of PAVM and review the literature. A 45-year-old woman with clinical signs and symptoms of PAVM was examined using several different scanning techniques, which showed a large PAVM in the lower lobe of her right lung. A lobectomy was performed, which revealed a 5 cm diameter PAVM with one feeding artery and multiple veins. Intravenous angiography of a 7-year-old girl with symptoms of fatigue and acro-cyanosis confirmed the presence of a large PAVM in her right lower lobe. The PAVM had two major arteries arising from the aorta, which were ligated during a lobectomy. Both patients recovered well following surgery. Although PAVMs are rare, their neurological and haemodynamic consequences may be fatal. Interventional treatment techniques, including surge...
Annals of translational medicine, 2015
Pulmonary arteriovenous malformation (PAVM) is a rare clinical condition with abnormal direct communication between the branches of pulmonary artery and vein. It may occur as an isolated anomaly or in association with hereditary hemorrhagic telangiectasia (HHT). Although these vascular pulmonary pathologies are quite uncommon, they are the important part of the differential diagnosis of common pulmonary problems such as hypoxemia and pulmonary nodules. The diagnosis of PAVM in patients remains a diagnostic challenge to the emergency physician. The most common clinical signs of PAVM are recurrent episodes of epistaxis and hemoptysis, so surgical resection is deemed the best curative option to avoid further episodes and recurrence of hemoptysis. Quite often the diagnosis is established after pathohistological examinations. We report a case of a female patient with a massive recurrent hemoptysis and without pathologic radiological findings which would suggest to PAVM and who was succes...
Diagnosis and management of pulmonary arteriovenous malformations
Pulmonary arteriovenous malformation is a rare anomaly that presents in several different ways. It can present as an isolated finding, or more often in the context of hereditary haemorrhagic telangiectasia. It can also complicate palliative surgery such as the Glenn operation for complex congenital heart disease with single ventricle physiology. Its management includes transcatheter embolization, which is the preferred mode of therapy, surgery (including resection of the affected lobe, segment, or the fistula itself), or rarely, medical therapy. Complications of the disease itself and of various modes of treatment are relatively common, and patients require close surveillance for possible recurrence, or development of new fistulas. In cases related to the Glenn operation, redirection of hepatic venous flow or heart transplantation may cure the problem.
Current Challenges in Thoracic Surgery
Background: Pulmonary arteriovenous malformations (PAVM) are abnormal direct connections between arteries and veins of the pulmonary circulatory system. In the majority of cases, they are of congenital origin and patients present with dyspnea, epistaxis or hemoptysis as the most common clinical symptoms. Before surgical treatment is considered, patients should be discussed interdisciplinary with angiologists and interventional radiologists regarding evaluation of embolotherapy. In case of unsuccessful embolotherapy, in case of complications (e.g., bleeding due to rupture of lesions), or in patients with contraindication for embolization such as untreatable contrast allergy, surgical resection of the pulmonary lesion is indicated. The former gold standard of open thoracotomy as treatment of PAVM has been mostly replaced by interventional embolization since the late 1980s. In recent years, less invasive approaches such as multi-or uniportal videoassisted thoracic surgeries (VATS) developed, have improved and have been shown to be safe and feasible treatment options, when surgery is necessary. Methods: Between October 2015 and August 2019 five patients suffering from PAVM or its complications underwent a uniportal lung-sparing VATS resection at our department. Four out of the five patients have been successfully treated with a sublobar resection (segmentectomy of one or two lung segments). In another patient, an extended vascular malformation between the superior phrenic artery and the inferior pulmonary vein was approached via wedge resection of the affected lung in a first step and embolization of the subphrenic part in a second step as decided in an interdisciplinary setting before treatment. Results: The median hospital stay was 4 days (range, 2-5 days) and, in all surgically treated patients, the postoperative course was uneventful. Only one of the five patients who suffered from hereditary hemorrhagic telangiectasia showed recurrence of the disease in the form of new vascular malformations in other lobes on CT scan 9 months after surgery, although so far asymptomatic. All other patients had an uneventful longtime course (median follow-up: 17 months; range, 5-52 months). Conclusions: The uniportal VATS technique is one of the least invasive approaches in thoracic surgery: It allows not only for lung-sparing anatomical lung resections in the form of segmentectomies, but is also associated with very low morbidity and complication rates. Therefore, uniportal VATS is an excellent therapeutic option in selected cases in which primary interventional measures fail or complications of PAVM occur.
Implications of an Incidental Pulmonary Arteriovenous Malformation
Journal of investigative medicine high impact case reports
Introduction. Pulmonary arteriovenous malformations (PAVMs) have been associated with life-threatening complications, such as stroke and massive hemoptysis, thus posing significant morbidity if left untreated. We report a case of an incidental finding of a PAVM in a trauma patient newly recognized to have suspected hereditary hemorrhagic telangiectasia (HHT). Case Description. A 34-year-old man with a history of recurrent epistaxis presented with a sudden fall associated with seizure-like activity. Trauma imaging showed a large subdural hematoma and, incidentally, a serpiginous focus within the right upper lobe with a prominent feeding artery consistent with a PAVM. The patient was diagnosed with a simple PAVM related to possible or suspected HHT, an autosomal dominant trait with age-related penetrance. He underwent a pulmonary arteriography of the right upper and lower lobe with the use of a microcatheter system; however, the PAVM could not be visualized. Thus, he was managed medic...
2020
Pulmonary arteriovenous malformations (AVMs) are rare anomalies of the pulmonary vasculature. Sixty percent of patients with pulmonary AVMs’ are asymptomatic, while rest 40% can present with a myriad of symptoms, the commonest being dyspnea. Although percutaneous embolization has emerged as the gold standard in the treatment of pulmonary AVM, surgery is still indicated in some cases. Video-assisted thoracoscopic surgery (VATS) lung resections has gained popularity and has been proven to have less morbidity, compared to conventional thoracotomy. A 53-year-old male, which a previous history of seizure, was admitted following a motor vehicle accident. He was intubated for respiratory distress. CT thorax was done for evaluation of chest trauma and pulmonary AVM was noted at the lower lobe of the right lung. Post extubation, patient still required high oxygen supplementation. Due to the size of the AVM, he was planned for right lower lobectomy. He underwent transcatheter embolization pri...
Endovascular Management of Pulmonary Arteriovenous Malformation
Bahrain Medical Bulletin, 2014
Although many studies showed that pulmonary arteriovenous malformations (PAVM) are relatively rare disorders, they are still an important part of differential diagnosis of common pulmonary problems such as hypoxemia, dyspnea on exertion and pulmonary nodules. A thirty-five-year-old female patient presented with low oxygen saturation six hours post simple vaginal delivery. The patient was investigated by echocardiography, chest x-ray and CT pulmonary angiography, which confirmed the diagnosis of pulmonary arteriovenous malformations (PAVM). Pulmonary conventional angiogram with transcatheter coil embolization was performed to treat the condition. The patient had uneventful recovery following coil embolization of pulmonary arteriovenous malformations. Patient may present with symptoms related to PAVM, such as dyspnea on exertion, finger clubbing, cyanosis, hemoptysis and chest pain or underlying hereditary hemorrhagic telangiectasia (HHT), epistaxis and skin telangiectasia 3-6. The aim of this report is to present a case report of pulmonary arteriovenous malformation which was treated by transcatheter coil embolization. ______________________________________________________________________________ * Senior Registrar