View
216
Download
1
Category
Tags:
Preview:
Citation preview
A CASE OF PULMONARY ARTERIOVENOUS MALFORMATION PRESENTING AS HAEMOPTYSIS ABSTRACT NO:IRIA 1084
67 year old lady with complaints of haemoptysis
She is a known case of systemic hypertension with severe tricuspid regurgitation and PAH.
ECHO revealed severe tricuspid regurgitation with dilated right atrium and ventricle, suggestive of severe PAH
CT Scanogram
CT scanogram showing well defined radio dense nodule in right lower zone behind the cardiac shadow with pruning of pulmonary vessels ,enlarged pulmonary trunk and cardiomegaly
Plain CT showing well defined radio dense lobulated nodule in the posterior segment of right lower lobe.
Nodule is enhancing equal to the main pulmonary artery with appearance of early draining vein
Arterial supply from right lower
lobe pulmonary artery and
draining into right inferior pulmonary
vein
CT thorax features are consistent with pulmonary AV fistula supplied by right lower lobe pulmonary artery and venous drainage into inferior pulmonary vein
Diagnosis was confirmed with catheter angiography
Enlarged lower lobe pulmonary artery with sac filling with contrast draining into the inferior pulmonary vein
Endovascular embolisation device
Post embolisation
Post embolisation angiogram shows complete obliteration of the AV fistula
DiscussionPulmonary arterio venous malformations are lesions of pulmonary vasculature that by pass the capillary system flowing from arteries directly into veins
Incidence 2-3 per 100 000 population
More common in females than in male 2:1
Types
Simple -Single feeding artery empties into bulbous, non
septated aneurysmal segment -Single draining vein Complex -More than one feeding artery empty
into septated, aneurysmal segment - More than one draining vein
1.Surgery 2.Endovascular embolisation a. Coil b. vascular plug
Treatment options
CONCLUSIONPulmonary AVM is a rare vascular
malformation of lung.Contrast CT/CT angio has high specificity
and sensitivity.Endovascular embolisation is the most
effective and least invasive choice of treatment.
REFERENCE Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD
Imaging in Arteriovenous Lung Malformation medscape Nov 7, 2013
I khurshid ,G H Downie Postgrad Med J Pulmonary arteriovenous malformation 2002;78:191197 doi:10.1136/pmj.78.918.191
Hodgson CH,Kaye RL. Pulmonary arteriovenous fistula and hereditary telangiectasia.Dis Chest1963;43:449–55
Packard GB, Waring JJ. Arterio-venous fistula of the lung treated by ligation of the pulmonary artery. Arch Surg1945;56:724–40.
Recommended