Bilateral Pulmonary Arteriovenous Malformation in Female Patient Based on Computed Tomography Imaging: A Rare Case Report
Abstract
Background: Pulmonary arteriovenous malformations (PAVMs) is an extremely rare vascular anomaly due to a direct connection between the pulmonary artery and pulmonary vein, potentially causing irreversible damages to the systemic circulation. This condition requires a prompt diagnostic approach to ensure early diagnosis and treatment.
Case Report: A 53-year-old Indonesian female was referred to our department with unexplained dyspnoea and cyanosis. Physical examination revealed low oxygen saturation and remarkable finding on pulmonary auscultation. Further investigation revealed the findings suggesting PAVM based on contrast-enhanced chest computed tomography (CT) scan, with multiple nidus on bilateral lungs with feeder arteries from the pulmonary artery and draining veins in the pulmonary vein. Hence, this case emphasizes the rare finding of a female PAVMs patient with bilateral PAVMs.
Conclusion: CT scan is a reliable and effective imaging approach to establish the diagnosis of PAVMs. This modality should be first considered to visualize PAVMs lesions, particularly in adult patients with unexplained dyspnoea and cyanosis.
Keywords: arteriovenous malformations, CT scan, rare case, embolization
Correspondence: Sony Sutrisno. Department of Radiology, Faculty of Medicine and Health Sciences, Krida Wacana Christian University, Jakarta, Indonesia. Email: sonysutrisnodr@gmail.com. Mobile: +62-8128-9290-414.
Indonesian Journal of Medicine (2021), 06(04): 393-398
https://doi.org/10.26911/theijmed.2021.06.04.05
References
Andersen PE, Kjeldsen AD (2010). Interventional treatment of pulmonary arteriovenous malformations. World J Radiol. 2(9): 339344. https://doi.org/10.4329/wjr.v2.i9.339.
Circo S, Gossage JR (2014). Pulmonary vascular complications of hereditary haemorrhagic telangiectasia. Curr Opin Pulm Med. 20(5): 421428. doi: 10.1097/MCP.0000000000000076.
Hsu CC, Kwan GN, EvansBarns H, van Driel ML (2018). Embolisation for pulmonary arteriovenous malformation. Cochrane Database Syst Rev. 1 (1): CD008017. https://dx.doi.org/10.1002%2F14651858.CD008017.pub5.
Karavdic K, Pilav I, Guska S, Begic Z, Mesic A, Krstic S, et al. (2018). Symptomatic pulmonary arteriovenous malformations in a 10 year old boy – a case report. Med Case Rep. 4(2): 14. doi: 10.21767/24718041.100101.
Ko JS, Kwon LM, Kim HM, Woo JY, Kim YN, Moon JW (2021). Angiographic findings of an isolated meandering pulmonary vein: a case report. J Korean Soc Radiol. 82(4): 10181023.
Kuhajda I, Milosevic M, Ilincic D, Kuhajda D, Pekovic S, Tsirgogianni K, et al. (2015). Urgent awake thoracoscopic treatment of retained haemothorax associated with respiratory failure. Ann Transl Med. 3(12): 171175. https://doi.org/10.3978/j.issn.23055839.2015.04.13.
McDonald J, WooderchakDonahue W, Van Sant WC, Whitehead K, Stevenson DA, BayrakToydemir P (2015). Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Front Genet. 6: 1. https://doi.org/10.3389/fgene.2015.00001.
Mohammed M, Hrfi A, AlQwee A, Tamimi O (2018). Pulmonary arteriovenous malformation in a neonate: a condition commonly misdiagnosed. Sudan J Paediatr. 18(2): 5660. https://dx.doi.org/10.24911%2FSJP.1061528143670.
Nakayama M, Nawa T, Chonan T, Endo K, Morikawa S, Bando M, et al. (2012). Prevalence of pulmonary arteriovenous malformations as estimated by lowdose thoracic CT screening. Intern Med. 51(13): 16771681. https://doi.org/10.2169/internalmedicine.51.7305.
Narshinh KH, Kinney TB (2013). Management of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasis patients. Semin Intervent Radiol. 30(4): 408412. https://dx.doi.org/10.1055%2Fs00331359736.
Pollak JS, Saluja S, Thabet A, Henderson KJ, Neil Denbow RIWJ (2006). Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 1(45):35–44. https://doi.org/10.1097/01.rvi.0000191410.13974.b6.
Post MC, Van Gent MW, Plokker HW, Westernmann CJ, Kelder JC, Mager JJ, et al. (2019). Pulmonary arteriovenous malformations associated with migraine with aura. Eur Respir J. 34: 882887. https://doi.org/10.1183/09031936.00179008.
Sharifah AIM, Jasvinder K, Rus AA (2009). Pulmonary arteriovenous malformation; a rare cause of cyanosis in a child. Singapore Med J. 50(4): e12729.
Shovlin CL (2014). Pulmonary arteriovenous malformations. Am J Respir Crit Care Med. 190(11): 12171228. https://doi.org/10.1164/rccm.2014071254CI.
Silva ALM, de Melo Junior FA, de Mattos APS, Meira SS (2016). Pulmonary arteriovenous malformation: case report. J Health Sci Inst. 34(4): 246248.
Verhelst X, Geerts Am Lecluyse C, Vlierberghe H Van, Smeets P (2018). Severe hepatic and pulmonary involvement in RenduOslerWeber Syndrome. Case Rep Gastroenterol. 12(1): 138. https://doi.org/10.1159/000486189.
Wehner LE, Folz BJ, Argyriou L, Twelkemeyer S, Teske U, Geisthoffet UW, et al. (2006). Mutation analysis in hereditary haemorrhagic telangiectasia in Germany reveals 11 novel ENG and 12 novel ACVRL1 / ALK1 mutations. Clin Genet. 69(3): 239245. https://doi.org/10.1111/j.13990004.2006.00574.x.
White RI (2007). Pulmonary arteriovenous malformations: how do I embolize?. Tech Vasc Interventional Rad. 10(4): 283290. https://doi.org/10.1053/j.tvir.2008.03.007.
Woodward CS, Pyeritz RE, Chittams JL, Trerotola SO (2013). Treated pulmonary arteriovenous malformations: patterns of persistence and associated retreatment success. Radiology. 269 (3): 919926. https://doi.org/10.1148/radiol.13122153.
