Pitfalls in the diagnosis of pulmonary arteriovenous malformations

1994 ◽  
Vol 4 (4) ◽  
pp. 408-410
Author(s):  
Michael Schiemmer ◽  
Gerald Tulzer ◽  
Maria Wimmer
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Angiography ◽  
Arterial Oxygen ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Diagnostic Pitfalls

SummaryA homogeneous opacity of the right upper lobe was found radiographically in a 15-month-old male child during investigation of an upper respiratory tract infection. Based on computerized tomography, the diagnosis was made of a solid tumor of the lung. At thoracotomy, dilated serpentine vessels were found on the surface of the right upper lobe, and the diagnosis of a large arteriovenous malformation was considered. Use of enhanced computed tomography without contrast and failure to note a reduced arterial oxygen saturation were two diagnostic pitfalls. The diagnosis of an arteriovenous malformation was confirmed by pulmonary angiography, and a right upper lobectomy was successfully performed.

Bubble contrast echocardiography in detecting pulmonary arteriovenous malformations after modified Fontan operations

2001 ◽  
Vol 11 (5) ◽  
pp. 505-511 ◽  
Author(s):  
Eva Strömvall Larsson ◽  
Laszlo Solymar ◽  
Bengt O. Eriksson ◽  
Anne de Wahl Granelli ◽  
Mats Mellander
Keyword(s):  
Arteriovenous Malformations ◽  
Contrast Echocardiography ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Positive Contrast ◽  
Pulmonary Angiography ◽  
Arterial Oxygen ◽  
Colloid Solution ◽  
Pulmonary Arteriovenous Malformations ◽  
The Right

The development of pulmonary arteriovenous malformations is a well-known complication after Fontan operations, and may result in significant morbidity due to increasing arterial desaturation. We compared the use of bubble contrast echocardiography and pulmonary angiography in detecting such malformations. We also examined which anatomical and haemodynamic variables were associated with their development. Our study includes 20 patients who had undergone modified Fontan procedures, 10 with atriopulmonary and 10 with total cavopulmonary connections, in Gothenburg between 1980 and 1991. All patients underwent cardiac catheterisation and pulmonary angiography. Bubble contrast echocardiography was performed at the same time, with injection of agitated polygelin colloid solution (Haemaccel, Hoechst) into the right and left pulmonary arteries, respectively. Transoesophageal echocardiography was used to detect the appearance of bubble contrast in the pulmonary venous atrium. The aim was also to evaluate the role of hepatic venous blood. Of the 20 patients, 9 (45%) had a positive contrast echocardiography study, compared with only 2 (10%) detected by pulmonary angiography. Patients with positive contrast echocardiography had a significantly lower arterial oxygen saturation than those with negative studies, both at rest (88% vs 95%, p < 0.01) and during exercise testing (78% vs 89%, p = 0.01). Bubble contrast echocardiography is much more sensitive in detecting pulmonary arteriovenous malformations than pulmonary angiography. By injecting echo contrast into the right and left pulmonary arteries, the method can be made highly selective. Pulmonary arteriovenous malformations develop much more frequently in patients with the Fontan circulation than previously reported.

scholarly journals Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xu Ma ◽  
Bing Jie ◽  
Dong Yu ◽  
Ling-Ling Li ◽  
Sen Jiang
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pulmonary Arteriovenous Malformations ◽  
Imaging Data ◽  
Peripheral Lung ◽  
Life Threatening ◽  
The Mean

Abstract Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.

Balloon dilation of the right ventricular outflow tract in tetralogy of Fallot: a palliative procedure

1999 ◽  
Vol 9 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Sameh M. Arab ◽  
Abdel-Fattah E. Kholeif ◽  
Salah R. Zaher ◽  
Aly M. Abdel-Mohsen ◽  
A. Samir Kassem ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Balloon Dilation ◽  
Right Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Arterial Oxygen ◽  
Palliative Procedure ◽  
The Mean ◽  
The Right

AbstractFifteen patients requiring palliation for tetralogy of Fallot were treated by balloon dilation because of hypercyanotic spells. The mean age at dilation was 1.9 ± 0.7 years (range 0.5 – 3), and the mean weight 9.8 ± 2.1kg (range 6.0 –13.5). Dilation of the outflow tract was combined with dilation of the left and/or right pulmonary arteries in 5 patients. Successful dilation was achieved in 12 patients (80%), but failed in 3 patients with hypoplastic pulmonary arteries. In one patient, the stenosis of the right pulmonary artery could not be dilated because of a very sharp angle at the site of the stenosis. Two of the 3 patients in whom the procedure failed died of severe cyanotic spells within 24 hours of the unsuccessful procedure. No major complications occurred during or after the procedure in the cases undergoing successful dilation. The arterial oxygen saturation increased significantly, from 71 ± 5.7% to 89 ± 3.9%, immediately after the procedure (p < 0.005). During a period of follow up of 6 ± 3.7 months (range 1 – 13), the procedure was repeated on 3 occasions, and successfully accomplished in 2 of these. In conclusion, balloon dilation is a satisfactory palliative procedure for tetralogy of Fallot in those units in which total correction is not performed under 2 to 3 years of age.

Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

2019 ◽  
Vol 29 (8) ◽  
pp. 1036-1039
Author(s):  
Yoichi Kawahira ◽  
Kyoichi Nishigaki ◽  
Koji Kagisaki ◽  
Takuji Watanabe ◽  
Kazuki Tanimoto
Keyword(s):  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Systolic Pressure ◽  
Cardiac Repair ◽  
Long Term Results ◽  
Arterial Oxygen ◽  
The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

scholarly journals Hemicranial Cough-Induced Headache as a First Symptom of a Carotid-Cavernous Fistula-Case Report

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 194
Author(s):  
Svetlana Simić ◽  
Ljiljana Radmilo ◽  
José R. Villar ◽  
Aleksandar Kopitović ◽  
Dragan Simić
Keyword(s):  
Aneurysm Rupture ◽  
Upper Respiratory Tract ◽  
Carotid Cavernous Fistula ◽  
Laboratory Findings ◽  
Cavernous Fistula ◽  
Upper Respiratory ◽  
Magnetic Resonance Imaging Mri ◽  
Angiographic Examination ◽  
The Right ◽  
Carotid Cavernous Fistulas

Background and objectives: Spontaneous carotid-cavernous fistulas (CCFs) are rare, and they may be caused by an aneurysm rupture. Materials and Methods: A case of a man hospitalized for high-intensity hemicranial headache with sudden cough onset as part of an upper respiratory tract infection is presented. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. Neurological finding registered a wider rima oculi to the right and slight neck rigidity. Laboratory findings detected a mild leukocytosis with neutrophil predominance, while cytobiochemical findings of CSF and a computerized tomography (CT) scan of the endocranium were normal. Results: Magnetic resonance imaging (MRI) angiography indicated the presence of a carotid cavernous fistula with a pseudoaneurysm to the right. Digital subtraction angiography (DSA) was performed to confirm the existence of the fistula. The planned artificial embolization was not performed because a complete occlusion of the fistula occurred during angiographic examination. Patient was discharged without subjective complaints and with normal neurological findings. Conclusions: Hemicranial cough-induced headache may be the first sign of carotid cavernous fistula, which was resolved by a spontaneous thrombosis in preparation for artificial embolization.

Arteriovenous Malformation of the Forearm as a Result of a Persistent Median Artery

1998 ◽  
Vol 23 (6) ◽  
pp. 820-821 ◽  
Author(s):  
L. KRISHNAMOORTHY ◽  
M. S. C. MURISON ◽  
P. J. SYKES
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Anterior Interosseous Artery ◽  
Unusual Variant ◽  
Interosseous Artery ◽  
Median Artery ◽  
Operative Findings ◽  
The Right

Most arteriovenous malformations usually arise from pre-existing named vessels. We report an unusual variant of an arteriovenous malformation. An 18-year-old man presented with a painful swelling of the right forearm. Arteriograms suggested branches of the anterior interosseous artery were feeding the malformation. Operative findings however, revealed the presence of a persistent median artery, which was contributing branches to the swelling.

scholarly journals Pulmonary Arteriovenous Malformation as a Cause of Exercise Intolerance in Children: A Case Report

2020 ◽  
Author(s):  
Pierluigi Morreale ◽  
Veronica Notarbartolo ◽  
Giancarlo Allegro ◽  
Francesca Finazzo ◽  
Mario Giuseppe Vallone ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Arterial Oxygen Saturation ◽  
Oxygen Desaturation ◽  
Exercise Intolerance ◽  
Pulmonary Arteriovenous Malformation ◽  
Arterial Oxygen ◽  
Selective Embolization ◽  
Insidious Onset ◽  
Bubble Test ◽  
Angio Ct

Pulmonary arteriovenous malformation (PAVMs) in children are rare lesions characterized by abnormal low resistance vascular structures connecting a pulmonary artery to a pulmonary vein, resulting in an intrapulmonary right-to-left shunt. The insidious onset and variable signs&amp;nbsp;and symptoms make diagnosis difficult, especially in children. PAVMs&amp;nbsp; can be single or multiple, congenital or acquired, and up to 47-80% of cases are associated with hereditary hemorrhagic telangiectasia (HHT).We present the&amp;nbsp; case of a 12-year-old female teenager referred to our center for epistaxis, headache, fatigue and weakness, with evidence of mild oxygen desaturation.&amp;nbsp; Bubble test showed a right-to-left shunt and pulmonary angio-CT confirmed the diagnosis. Percutaneous selective embolization was performed with full recovery of normal arterial oxygen saturation. When differentiating between mild oxygen desaturation and exercise intolerance in children and adolescents, physicians should be aware of the possibility of PAVMs as a cause.&amp;nbsp;

What should we know about antibacterial therapy for respiratory infections in children. The right start ensures a successful finish

2020 ◽  
Vol 18 (4) ◽  
pp. 195-200
Author(s):  
S.V. Nikolaeva ◽  
◽  
D.V. Usenko ◽  
S.V. Shabalina ◽  
L.V. Feklisova ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Respiratory Infections ◽  
Nasal Congestion ◽  
Clinical Manifestations ◽  
Upper Respiratory Tract ◽  
Inappropriate Use ◽  
Significant Public Health ◽  
Upper Respiratory ◽  
The Right ◽  
Tract Infections

Despite significant public health efforts, acute respiratory infections (ARIs) are still very common among children. Most ARIs (both mono- and mixed forms that became more frequent recently) are caused by viruses. Inappropriate use of antibiotics in patients with ARIs leads to an increase in antibiotic resistance, which is a highly relevant problem now. Administration of antibiotics requires an individual approach and better knowledge of practitioners regarding the problem of antibiotic resistance. Since clinical manifestations of upper respiratory tract infections (that represent a large proportion of all ARIs in children) include both general intoxication symptoms (fever, decreased appetite, weakness, and fatigue) and local symptoms (nasal congestion, rhinorrhea, sore throat increasing during swallowing, and cough) and the most common pathogens causing ARIs are viruses, local anti-inflammatory and bactericidal agents in the form of gargles or tablets for resorption are preferable. Key words: respiratory infections, children, mixed infection, Faringosept

Arterial blood gases of the domestic hen

1965 ◽  
Vol 208 (4) ◽  
pp. 798-800 ◽  
Author(s):  
Hugo Chiodi ◽  
James W. Terman
Keyword(s):  
Arterial Oxygen Saturation ◽  
Venous Blood ◽  
Blood Gases ◽  
Arterial Oxygen ◽  
Dissociation Curve ◽  
Arterial Blood Gases ◽  
Blood Samples ◽  
Arterial Blood ◽  
The Right ◽  
Domestic Hen

Individual blood samples were collected anaerobically from the brachial arteries of adult White Rock hens and were analyzed for Po2, Pco2, pH, oxygen content and capacity, and CO2 content and capacity. A dissociation curve was constructed from data on equilibration of pooled venous blood. The average arterial oxygen saturation was 90%, the Pco2 was about 32 mm Hg, the Po2 was between 94 and 99 mm Hg, and the pH averaged 7.49. The dissociation curve, as has been shown before, was shifted to the right of most homeothermic species.

scholarly journals TRATAMENTO CIRÚRGICO DE MALFORMAÇÃO ARTERIOVENOSA DA MUCOSA JUGAL: RELATO DE CASO

2019 ◽  
Author(s):  
Fernanda Britto de Melo Silva
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Surgery ◽  
Arteriovenous Malformations ◽  
Maxillofacial Surgery ◽  
The Body ◽  
Postoperative Result ◽  
Surgical Case ◽  
Gradual Onset ◽  
Capillary Bed ◽  
The Right

ResumoAs malformações arteriovenosas (MAV) são alterações congênitas dos vasos sanguíneos e, em casos raros, surgem apenas na idade adulta. A MAV apresenta comunicação direta entre uma artéria e uma veia que passam pelo leito capilar. Elas podem ocorrer em qualquer área do corpo e têm início e progressão graduais. O objetivo deste estudo é apresentar um caso cirúrgico de malformação arteriovenosa envolvendo a mucosa jugal direita de um paciente masculino de 16 anos de idade, tratado cirurgicamente em conjunto com o serviço de Cirurgia Vascular. O resultado pós-operatório foi satisfatório e a inter-relação entre os serviços de Cirurgia Maxilofacial e Vascular foi essencial para a realização de um procedimento cirúrgico mais seguro e previsível.Palavras-chave: Malformação arteriovenosa; cirurgia Maxilofacial; interdisciplinaridadeAbstractThe arteriovenous malformations (AVM) are congenital alterations of the blood vessels, and in rare cases, they develop only in adulthood. AVM present direct communications between an artery and a vein bypassing the capillary bed. They can occur at any area of the body and have gradual onset and progression. The aim of this study is to present a surgical case of arteriovenous malformation involving the right buccal mucosa of a 16-year-old male, which was managed with Vascular Surgery service. The postoperative result was satisfactory and interrelationship between Maxillofacial and Vascular Surgery services was essential for a safer and more predictable surgical procedure.Key-words: Arteriovenous malformation; Maxillofacial Surgery; interdisciplinarity  

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