scholarly journals Concurrent pulmonary arteriovenous malformation and pulmonary embolism causing stroke: a therapeutic dilemma

2022 ◽  
Vol 5 (1) ◽  
Author(s):  
Jung Guen Cha ◽  
Jihoon Hong
Keyword(s):  
Pulmonary Embolism ◽  
Arteriovenous Malformation ◽  
Treatment Plan ◽  
Rare Condition ◽  
Paradoxical Embolism ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Acute Infarction ◽  
Shunt Occlusion ◽  
The Right

Abstract Background As pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. A concurrent PAVM and pulmonary embolism (PE) is a rare condition. Therefore, the sequence of management has not been established. Case presentation A 62-year-old female patient was transferred to our hospital with a sporadic simple PAVM and concurrent bilateral PE. On chest computed tomography (CT), the acute PE was extended to the segmental pulmonary artery where the feeding artery of PAVM originated. Despite the anticoagulation, the patient complained of left sided weakness on the fifth day of admission, and magnetic resonance imaging revealed an acute infarction in the right lateral thalamus, which was thought to be caused by paradoxical embolism. This situation could lead to a dilemma between the risk of thrombus migration during PAVM embolization and another embolic event due to delayed shunt occlusion during anticoagulation. After a multidisciplinary discussion, a delayed endovascular embolization was performed for PAVM after confirming the complete resolution of PE with 4 months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome. Conclusion The authors reported a rare case of concurrent PAVM and PE that led to an embolic stroke during hospitalization. This patient was managed with delayed endovascular embolization for PAVM after an anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

scholarly journals Pulmonary Arteriovenous Malformation in Combination With Stroke.

2021 ◽  
Author(s):  
Jung Guen Cha ◽  
Jihoon Hong
Keyword(s):  
Pulmonary Embolism ◽  
Arteriovenous Malformation ◽  
Treatment Plan ◽  
Brain Magnetic Resonance Imaging ◽  
Rare Condition ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Feeding Artery ◽  
Complex Situation ◽  
Segmental Artery

Abstract BackgroundAs pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. There are few PAVM patients accompanied by concurrent pulmonary embolism, so the treatment sequence has not been established. Case presentationA 62-year-old female patient was transferred to our hospital with a simple PAVM and concurrent bilateral pulmonary embolism (PE). The acute thromboembolus was extended to the proximal segmental artery where the feeding artery originated. Anticoagulation was started, but on the fifth day of admission, the patient complained of left side weakness and brain magnetic resonance imaging revealed an acute infarction in the right lateral thalamus. This situation could lead to a dilemma between the risk of thrombus migration during catheter manipulation in PAVM embolization and another embolic event due to the late occlusion of the shunt during anticoagulation. This complex situation was successfully managed with delayed endovascular embolization for PAVM after four months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome (APS).ConclusionThe authors reported a rare case of APS-induced PE in the PAVM feeding artery course that led to stroke during hospitalization. We successfully treated this patient with delayed endovascular embolization for PAVM after anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

scholarly journals Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jihoon Hong ◽  
Sang Yub Lee ◽  
Jung Guen Cha ◽  
Jae-Kwang Lim ◽  
Jongmin Park ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Conventional Angiography ◽  
Receiver Operating Characteristic Curves ◽  
Vein Diameter ◽  
Diameter Reduction

Abstract Background To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard. Methods A retrospective review was done of patients from 2008 to 2019 with a PAVM treated with endovascular embolization. The treatment outcome was determined by conventional angiography. Follow-up pulmonary angiography was performed when recanalization was suspected on CT, or embolization of all lesions in multiple PAVM patients could not be completed in a single session. Patients who had no preprocedural or follow-up CT were excluded. Draining vein, feeding artery, and venous sac diameter were measured on CT, and diameter reduction rates were compared with the widely-used, binary 70 % criteria. Results Forty-one patients with 114 PAVMs were treated during the study period. Eight patients with 50 PAVMs met the inclusion criteria. Mean vein, artery, and venous sac diameter reduction rates were as follows: 59.2 ± 9.3 %, 47.5 ± 10.6 %, and 62.6 ± 13.2 %, respectively, in the occluded group and 5.4 ± 19.5 %, 11.3 ± 17.7 %, and 26.8 ± 14.2 %, respectively, in the recanalized group. The area under the receiver operating characteristic curves for PAVM recanalization for the draining vein was 1.00, showing a better result than the artery (0.97) and sac (0.99). Patients showed > 42 % draining vein diameter reduction in the occluded group and < 32 % in the recanalized group. The widely-used 70 % criteria showed low specificity for predicting recanalization (draining vein, 7.3 %; venous sac, 41.7 %) but 100 % sensitivity for both the draining vein and venous sac. Conclusions The widely-used 70 % binary criteria showed limited performance in predicting outcomes in this angiographically-confirmed case series. Further investigations are warranted to establish a strategy for detecting recanalization after PAVM embolization.

scholarly journals The experience of simultaneous endovascular occlusion of arteriovenous malformation and saccular aneurism in a parturient woman

2020 ◽  
Vol 30 (4) ◽  
pp. 79-87
Author(s):  
D.V. Shchehlov ◽  
S.V. Konotopchyk ◽  
I.N. Bortnyk ◽  
O.E. Svyrydiuk ◽  
M.Yu. Mamonova
Keyword(s):  
Arteriovenous Malformation ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Parietal Lobe ◽  
Endovascular Embolization ◽  
Saccular Aneurysm ◽  
Anterior Communicating Artery ◽  
Parturient Woman ◽  
Left Lateral Ventricle ◽  
The Right

The clinical case of simultaneous endovascular bloodstream exclusion of arteriovenous malformation and saccular aneurysm in parturient woman is presented. Onyx liquid adhesive composition and monospiral aneurysm occlusion technique were used. Patient X., 31, was hospitalized to the clinic on the 10th day of the postpartum period. From the anamnesis: twice (at 20th and 27th weeks of pregnancy) patient suffered intraventricular hemorrhage due to the rupture of arteriovenous malformation in the posterior third of the corpus callosum, left lateral ventricle and left parietal lobe of the brain. After the first hemorrhage a conservative treatment tactic was determined, given the high risk of complications associated with the surgical intervention for the mother and fetus. After the second hemorrhage endovascular embolization of malformation was suggested, however, the patient and her husband refused surgery, preferring conservative therapy with subsequent surgical treatment after delivery. In addition to the malformation, according to the data of selective cerebral subtraction angiography multiple cerebral saccular aneurysms of the left Anterior Cerebral – Anterior Communicating Artery and 2 Anterior Cerebral Artery aneurysms (A2-A2, A3-A4-segments) on the right side were diagnosed. Endovascular subtotal embolization of arteriovenous malformation and occlusion of the right Anterior Cerebral Artery (A2-A3-segment) saccular aneurysm were performed during the operation. A control angiographic examination after 3 months showed a complete exclusion of these arteriovenous malformation and saccular aneurysm and disappearance of all aneurysms of the left Anterior Cerebral Artery – Anterior Communicating Artery and right Anterior Cerebral Artery (A3-A4-segment).

Management of straddling thrombus through patent foramen ovale complicating pulmonary embolism

2021 ◽  
Vol 14 (4) ◽  
pp. e240957
Author(s):  
Vijeth Bhat ◽  
Stuart lane ◽  
Sam Orde
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Rare Condition ◽  
Bleeding Risk ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Haemodynamic Stability ◽  
Surgical Thrombectomy

A 60-year-old man was admitted to intensive care unit with the diagnosis of pulmonary embolism. Bedside transthoracic echocardiography revealed the extension of the thrombus into left atrium and ventricle through patent foramen ovale (PFO). A straddling thrombus also described as impending paradoxical embolism is a rare condition when thrombus embolised to the heart gets caught in PFO. Morbidity is extremely high in case of systemic embolisation. Due to rarity, the treatment options are mainly individualised and no guidelines exist. There are few treatment strategies described in literature from surgical to interventional radiology to conservative approach. Treatment strategy should take individual parameters such as patient’s age, haemodynamic stability, bleeding risk and comorbidities into consideration. Our patient successfully underwent emergency surgical thrombectomy.

Pulmonary arteriovenous malformation managed by VATS lobectomy

2020 ◽  
Vol 99 (10) ◽  
Keyword(s):  
Arteriovenous Malformation ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Pulmonary Veins ◽  
Pulmonary Arteries ◽  
Paradoxical Embolism ◽  
Pulmonary Arteriovenous Malformation ◽  
Vats Lobectomy ◽  
Pulmonary Capillaries ◽  
Gradual Development ◽  
Pulmonary Parenchyma

Introduction: Pulmonary arteriovenous malformation (PAVM) is formed by abnormal connections between pulmonary arteries and veins that bypass the pulmonary capillaries and transport deoxygenated blood through pulmonary veins to the left heart. This causes insufficient oxygenation of blood in the lungs. This condition remains symptomless for a long period of time. The most common symptoms include shortness of breath on exertion, nosebleeds, increased fatigue and a gradual development of cyanosis. Paradoxical embolism in the brain is a serious complication; it can present with a stroke or a brain abscess. Treatment of the disease consists of embolization of the pathological vascular connections, surgical resection of the affected pulmonary parenchyma and management of concomitant manifestations of the disease. PAVM in most common cases arises as a result of an autosomal dominant hereditary disorder referred to as hereditary hemorrhagic telangiectasia. Case report: In our communication, we document the diagnostic and therapeutic management in a young patient diagnosed with PAVM after falling off his bicycle. Based on comprehensive assessments, AV malformations with a 40% shunt of the pulmonary circulation were detected. An angiographic procedure was not an appropriate option considering the type and extent of the condition. Therefore, video-assisted thoracic resection of the affected pulmonary lobe was indicated. Conclusion: PAVM is a rare finding. PAVM should be ruled out in all patients with hereditary hemorrhagic telangiectasia (HHT) signs in the oral cavity. Contrast sonography of the heart and contract CT of the chest are the methods of choice for the diagnosis. Conservative or pharmacological treatment fails to improve the patient’s status. The condition is usually managed by embolization. Cases where PAVM is rather extensive or diffuse, where endovascular management would be inappropriate, can be well managed using endoscopic resection adequate to the extent of the condition.

scholarly journals P684 Paradoxical cerebral infarction due to massive pulmonary embolism in extracorporeal cardiopulmonary resuscitation and surgical embolectomy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Shiota ◽  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Carotid Artery ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Infarction ◽  
Massive Pulmonary Embolism ◽  
Paradoxical Embolism ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Surgical Embolectomy ◽  
The Right

Abstract Introduction Paradoxical cerebral infarction is a mechanism of acute ischemic stroke; however, definitive images to diagnose paradoxical embolism are not often obtained. We report a case of paradoxical cerebral embolism complicated with cardiac arrest due to massive pulmonary embolism. Case report A 40-year-old man presented due to sudden-onset chest pain, and was admitted to our hospital. He was restless and had cold sweat; we could not measure blood pressure. Electrocardiography showed wide QRS complex with right bundle branch block, and T wave inversion in leads V1 and III. Transthoracic echocardiography showed diffuse severe left ventricular hypokinesis, with slightly better inferior wall motion compared to other segments. Few minutes after arriving, he experienced cardiac arrest; chest compression was initiated. He was transported to the catheter laboratory, and veno-arterial extracorporeal membrane oxygenation was initiated subsequently. To diagnose the cause of arrest, we performed coronary angiography, which revealed no occluded coronary artery. Pulmonary angiograms showed bilateral proximal pulmonary artery occlusion with massive thrombi (panel A). Surgical embolectomy was performed after cardiac team discussion. After ICU admission post-surgery, pericardial effusion was increased, and the blood drained continuously from the chest tube; a large amount of blood transfusion was required. Reopen chest haemostasis was utilised. After the second ICU admission, anisocoria was observed; subsequent computed tomography showed low density and midline shift in almost the entire left cerebral hemisphere (Panel B). Carotid duplex ultrasound revealed a large thrombus saddled at the left carotid artery bifurcation (Panel C and D). We rechecked the transthoracic echocardiogram at arrival to reveal the cause of the cerebral infarction, which showed the thrombus to be at the ascending aorta (Panel E). We thought that the thrombi had moved from the lower limb to the right atrium. The massive pulmonary embolism increased the pulmonary artery and right atrial pressure, resulting in the lower pressure of the left atrium compared to that of the right atrium. The thrombi passed through the patent foramen ovale into the left atrium, moved into the left ventricle, and embolised the left internal carotid artery (Panel F). He expired due to severe neurologic injury from brain herniation. Conclusion In this case, although the pulmonary embolism was massive and led to cardiac arrest, the deteriorated haemodynamics improved by extracorporeal cardiopulmonary resuscitation and surgical embolectomy. However, we could not rescue the patient because of the severe neurological injury due to paradoxical embolism. Paradoxical cerebral infarction in pulmonary embolism is rare; however, we should pay careful attention to early detection of paradoxical cerebral infarction in pulmonary embolism and treatment for return of the patient to the former lifestyle. Abstract P684 figure

scholarly journals Pulmonary Arteriovenous Malformation presenting as hemothorax in pregnancy: A case report

2020 ◽  
Vol 23 (1) ◽  
pp. 47-49
Author(s):  
Dinesh Chataut ◽  
Sundar Suwal ◽  
Kamal Subedi ◽  
Ajit Thapa ◽  
Ram Kumar Ghimire ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Coil Embolization ◽  
Lower Lobe ◽  
Acute Onset ◽  
Pulmonary Arteriovenous Malformation ◽  
Image Guided ◽  
Inferior Pulmonary Vein ◽  
Promising Treatment ◽  
The Right

Introduction: Pulmonary arteriovenous malformation (PAVM) is a rare anomaly, mostly congenital, that tends to increase in size with the influence of various factors. Case report: A primigravida at 37 weeks of gestation presented with acute onset of dyspnea due to right sided hemothorax. Computed tomography showed abnormal vessels with pseudoaneurysm in the right lower lobe and shunting between subsegmental branch of right descending pulmonary artery and right inferior pulmonary vein. Embolization of the lesion was planned after immediate cesarean section. Coil embolization with complete occlusion of supplying artery of the lesion was done. Conclusion: PAVM, although rare can result in fatal complications if untreated. Less invasive image guided coil embolization is a promising treatment modality.

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