Hemothorax Due to Rupture of Pulmonary Arteriovenous Malformation

Berg, Adam M.; Amirbekian, Smbat; Mojibian, Hamid; Trow, Terence K.; White, Robert I.

doi:10.1378/chest.09-0344

Cited by 20 publications

(6 citation statements)

References 6 publications

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“…24,25 This can be managed with transcatheter embolization or if not immediately available, pulmonary isolation with a double-lumen endotracheal tube or bronchial blockade. 26,27 Finally, a right-to-left shunt through pulmonary AVMs may place the patient at risk of endocarditis and/or brain abscesses, thus antimicrobial prophylaxis should be considered. 8 Even after intervention on AVMs, silent ones can persist or develop overtime, thus, we suggest preoperative assessments for right-to-left shunts should take place and the aforementioned precautions should be utilized.…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child

McCann

Newlon

Krawiec

2020

J Pediatr Intensive Care

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Hereditary hemorrhagic telangiectasia (HHT) is an underrecognized genetic disorder of vascular development in pediatric patients. Its presentation can range from mild cutaneous findings to life-threatening hemorrhage from arteriovenous malformations. Clinical diagnosis can be challenging in the pediatric population as disease manifestations evolve over time and may be difficult to identify in younger patients. This case highlights how nonspecific symptoms and signs in the preanesthesia period can be misleading, potentially placing a patient with unrecognized HHT at risk for significant morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child

McCann

Newlon

Krawiec

2020

J Pediatr Intensive Care

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“…These AVMs are formed during development but generally do not become symptomatic until adolescence or later 4 . The architecture of the AVMs is fragile, and they are thus easily perturbed, leading to frequent bruising and bleeding 1, 5. The most common symptom of OWR syndrome, therefore, is frequent and persistent epistaxis, mucosal, palmar, and plantar telangiectasias, and visceral, cranial, or pulmonary AVMs 1 .…”

Section: Discussionmentioning

confidence: 99%

Fibrodysplastic implications for transvenous embolization of a high-flow pelvic arteriovenous malformation in Osler-Weber-Rendu syndrome

Nassiri

Thomas

Rahimi

2015

Journal of Vascular Surgery Cases

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Osler-Weber-Rendu syndrome is a rare genetic disorder that commonly features high-flow arteriovenous malformations (AVM) within the pulmonary, intracranial, and visceral circulation. We present a patient with a unique case of OslerWeber-Rendu syndrome featuring a high-flow pelvic AVM in addition to fibromuscular dysplasia affecting multiple vascular beds. This required a unique modification of our embolic therapeutic approach for adequate treatment of the AVM. (J Vasc Surg Cases 2015;1:16-9.) Osler-Weber-Rendu (OWR) syndrome is a rare genetic disorder that commonly features high-flow arteriovenous malformations (AVM) within the pulmonary, intracranial, and visceral circulation. We present a patient with a unique case of OWR syndrome featuring a high-flow pelvic AVM in addition to fibromuscular dysplasia (FMD) affecting multiple vascular beds. Consent to publish this case report was obtained from patient. CASE REPORTA 59-year-old woman with a history of OWR syndrome was evaluated in consultation for a symptomatic left pelvic AVM discovered on a computed tomography (CT) scan. Symptoms included a dull, throbbing ache, waxing and waning in severity, with exacerbation of symptoms after activity. She also reported a personal and first-degree relative history of chronic, persistent epistaxis. Her physical examination was remarkable for multiple, widespread erythematous macules (telangiectasias) throughout the volar aspect of the acral digits, tongue, and buccal mucosa (Fig 1, A and B). Left lower quadrant tenderness to deep palpation and a faint local bruit was appreciated.The CT scan confirmed the presence of large-caliber, tortuous arterial feeders supplying the nidus of a high-flow left pelvic AVM with prompt shunting into an aneurysmal draining vein, which eventually emptied into the left gonadal venous system (Fig 1, C). The arterial supply seemed to arise from the hypogastric or the gonadal arteries, or both. Results of the laboratory evaluation were unremarkable aside from mild microcytic anemia.The patient was offered a diagnostic angiography with the option for transcatheter embolization of this symptomatic, high-flow AVM.Technical details. The procedure was performed in a hybrid operating suite, with the patient under general anesthesia. No systemic anticoagulation was given; however, generous and frequent heparinized saline irrigation of sheaths and catheters was performed throughout the case. Flush aortography confirmed the presence of a high-flow AVM supplied by an enlarged, redundant, and extremely tortuous left gonadal artery, with prompt shunting into aneurysmal draining veins, which eventually emptied into the left gonadal venous system. No significant left renal vein hemodynamic abnormalities were noted. Selective catheterization of the left hypogastric artery revealed no association with the AVM. Also noted were diffuse, medial fibrodysplastic lesions with a characteristic chain of beads appearance involving the bilateral external iliac arteries and the left renal artery (Fig 2, A and B).Selective...

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“…10) in cases of ruptured PAVM. (15) Haemoptysis Life-threatening haemoptysis in patients presenting to the ED could be due to malignancy, bronchiectasis, tuberculosis or …”

Section: A 8bmentioning

confidence: 99%

Imaging in noncardiovascular thoracic emergencies: a pictorial review

Chawla¹

2015

smedj

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Hemothorax Due to Rupture of Pulmonary Arteriovenous Malformation

Cited by 20 publications

References 6 publications

Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child

Hypoxemia without Respiratory Distress: Hereditary Hemorrhagic Telangiectasia in a Child

Fibrodysplastic implications for transvenous embolization of a high-flow pelvic arteriovenous malformation in Osler-Weber-Rendu syndrome

Imaging in noncardiovascular thoracic emergencies: a pictorial review

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