A case of pulmonary arteriovenous malformation: role of interventional radiology in diagnosis and treatment

Abstract

Pulmonary arterio-venous malformations (PAVMs) are abnormal pulmonary arteries and pulmonary veins communicating directly without interposition of a capillary bed and about 80-90% of patients with PAVMs eventually may present with hereditary hemorrhagic telangiectasia (HHT), remaining ones are sporadic cases. On the other hand, about 15-35% of HHT patients may present with PAVMs. The PAVMs have a tendency to grow and increase in size over time and various factors like puberty, pregnancy and pulmonary arterial hypertension (PAH) affect growth. This condition needs early diagnosis, aggressive management and vigilant follow up. Our article aims to review pulmonary AVMs as a rare cause of strokes in young patients. We will discuss the clinical presentation, diagnosis, complications, the therapeutic options and the follow up.

Cholecystectomy under thoracic epidural anaesthesia for patient with severe intra‐pulmonary shunt

“…However, the majority of the operations were related to nasal cauterization and none of the patients had significant hypoxaemia . Other case reports of HHT with significant pAVMs have detailed principles of optimizing preoperatively with percutaneous image‐guided embolization to reduce the shunt burden . Fortunately, this had been performed in our case prior to the requirement for urgent surgery.…”

Elective left pulmonary artery embolisation for pulmonary arteriovenous malformations secondary to cavopulmonary anastomoses not responsive to heart transplantation: a case report

“…Pulmonary arteriovenous malformations are abnormal anastomoses between pulmonary arteries and veins causing insufficient oxygenation, dyspnoea, and cyanosis. 1 Pulmonary arteriovenous malformations can develop secondary to cavopulmonary anastomoses. The exact cause of their development is unknown, but multiple theories exist including lack of a "hepatic factor" to the affected lung 2 and lack of pulsatile flow through pulmonary arteries.…”

Hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations: clinical aspects

“…Most PAVMs in HHT are morphologically simple, consisting of a feeding vessel that originates from a single segmental pulmonary artery and connects to a draining pulmonary vein via a single aneurysmal nidus (21,22). Complex PAVMs are fed by more than one segmental pulmonary artery and may have multiple draining veins (23). Less than 10% of PAVMs are diffuse, defined as diffusely involving at least one lung segment (24), and have been associated with higher rates of hypoxemia and embolic complications (25,26).…”

“…Disruption of flow through PAVMs via transcatheter embolization has been the standard approach to management since the 1980s (22,23,36). Surgical resection of PAVMs, at one time the only definitive treatment option, is now rarely performed except when urgent treatment is required in settings where expertise in embolotherapy is lacking.…”