Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

Abstract

Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the nonsurgical and surgical therapeutic approaches are discussed.

High Output Cardiac Failure Due to Iatrogenic A—V Fistula in Scar: A Report of a Case and Review of the Literature

“…In our patient the fistula formed in scar at the site where a percutaneous drainage tube had been inserted following cardiac surgery. Similar cases of AVF developing after placement of a chest tube have been reported , but heart failure did not develop and the AVF was not in a precordial location [4,5].…”

Transcatheter coil embolization of an intercostal artery to pulmonary artery fistula

“…1 a The original chest Xray shows notching of the left seventh to ninth ribs. Dilated and tortuous left seventh intercostal artery (arrow) injections; b lower and c upper views reveal a single hole fistula (large arrow) located at left inferior lateral chest wall and drains toward the left main pulmonary trunk (double short arrow) via a transparenchymal pulmonary artery (short arrow) tubes), infections (actinomycosis, tuberculosis), and tumors [4,5]. This entity is distinct and different from vascular anomalous communications seen with pulmonary sequestration.…”

“…Systemic artery to pulmonary artery fistulas have been reported mostly as case reports or as a small series of two to three patients [1,2,3,4,5,6]. Patients are usually asymptomatic, and routine diagnostic tests may be of little value on establishing a diagnosis.…”

A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance

“…Shaughnessy et al found that 14 of their 20 infants with SPC did not demonstrate SPC on a prior echocardiogram at a mean age of eight days. Acquired SPC secondary to chronic alveolar hypoxia has also been described in infants and adults with pulmonary embolism, inflammatory, neoplastic and traumatic lung disease .…”