Congenital Arteriovenous Malformation of Lip - A Case Report

Vascular anomalies are a heterogeneous group of lesions involving vascular channels including the lymphatics. They encompass a wide variety of lesions from simple capillary haemangiomas to angiosarcomas. These lesions most commonly occur as a result of developmental error during embryogenesis due to defective signal process.1 Most of these lesions occur sporadically while a few may be inherited or acquired. Inherited lesions tend to be small and multi-centric which gradually increase its size with age.2 The International Society for the Study of Vascular Anomalies has broadly classified vascular anomalies into 2 groups: 1) Vascular neoplasms and 2) Vascular malformations.3 Vascular malformations are a relatively rare group of lesions involving the endothelium and surrounding tissue of arteries and veins resulting in an abnormal arteriovenous shunting. They are categorised into 4 types: 1) Venous malformation, 2) Capillary malformation, 3) Arteriovenous malformation and 4) Lymphatic malformation. They can occur anywhere in the body from head to toe, but they are most commonly seen in the brain. The most common extra-cranial site for AV malformations is the head and neck and other common sites include limbs, trunk and viscera.4 Here, we a present a rare case of congenital AV malformation of lip in a 49-year-old male.

Transcatheter Artery Embolization for Postoperative Haemorrhage after Arterio-Venous Malformation – Safer Option

Introduction: Hemorrhage is one of the commonest and dreaded complications especially with pelvic surgeries. Gestational trophoblastic neoplasias (GTN) are notorious for their propensity to bleed torrentially and metastasis to vital organs. GTN is associated with an arterio-venous malformation (AVM) about 10-15% of the time, which can lead to bleeding after surgery or after complete remission. After the failure of conventional management with chemotherapy or surgery one is compelled to take another modality of management. One of such methods is the use of transcatheter artery embolization in cases of GTN or post-hysterectomy cases of GTN. Transcatheter artery embolization (TAE) was effective in controlling bleeding due to arterio-venous malformation in 96% of cases.Case: 46 years P2L2A5 (para 2, living issue 2, abortion 5) post-hysterectomy patient presented with bleeding from the vagina after surgery. Twice she underwent vaginal vault repair after hysterectomy but failed. Ultrasonography (USG) showed arterio-venous malformation (AVM); angiography revealed massive extravasation from (left internal iliac artery and abnormal vascularity from the right internal iliac. She was taken up for bilateral internal iliac arteries embolization but again had a heavy bout of bleeding after one week. CT scan confirmed a residual lesion and she underwent a repeat embolization after which the bleeding stopped. Serum BHCG was advised during workup and it was 1997 IU/ml. A diagnosis of GTN was confirmed. The patient was discharged after two cycles of chemotherapy with advice to review for the third one on an outpatient department basis.Conclusion: We concluded that TAE is an effective and safer alternative to surgery in postoperative bleeding from AV malformation in the case of GTN. It can be repeated and should be made to more liberal use in emergency settings.

Rubeosis iridis and macular hemorrhages from multiple Corkscrew retinal vessels in a patient with NF1

Purpose: To report a case of a patient with NF1 presenting with ocular findings of AV malformation, multiple retinal hemorrhages, and neovascular glaucoma in the absence of retinal ischemia. Methods: Review of the medical record was conducted in accordance with the local IRBt. Results: A 60-year-old female patient with diagnosis of Neurofibromatosis type1 (NF1) and sudden decrease of vision in her left eye was found to have rubeosis iridis and high intraocular pressure (IOP). On fundus exam multiple corkscrew retinal vessels and retinal hemorrhages were present in her left eye. On Optical Coherence Tomography (OCT) the foveal hemorrhages appeared as outer layer hyperreflective retinal infiltrates whereas in the parafoveal area the hyperreflectivity was present between the RPE and neurosensory retina. Fluorescein Angiogram (FA) showed normal perfusion and no areas of leakage or ischemia. Treatment with anti-angiogenics in a timely manner correlated with a good visual outcome. Conclusions: We present a unique patient with NF1, rubeosis iridis, high IOP, and macular hemorrhages from multiple corkscrew retinal vessels in a well perfused retina, who underwent treatment with a single dose of intravitreal Bevacizumab and had an excellent response

A rare case on Rheumatic Heart Disease with Urosepsis and Septic shock

Rheumatic heart disease(RHD) is an inflammatory disease that mostly occurs in children of 5-15 years old. The major complications of RHD include arrhythmias, especially atrial fibrillation, stroke, infective endocarditis, cardiac failure, and also noted that problems increased in pregnancy. This is a rare case of RHD and urosepsis in a 67- year- old patient with a known history of cerebrovascular accident, pulmonary Arteriovenous(AV) malformation, acute renal failure, and hyponatremia presented to the emergency department with complaints of fever, severe breathlessness, and cough. The patient initially showed clinical manifestations of elevated inflammatory markers, neutrophilic leucocytosis, and hyponatremia, indicating septic shock. Our patient had been empirically treated with Piperacillin-Tazobactam because of the clinical features of urosepsis with septic shock. Based on Bronchoalveolar lavage(BAL) culture with non-fermenter Presumptive Acinetobacter and Klebsiella species and culture sensitivity report antibiotics were changed to Colistin and meropenem. The presence of carbapenem-resistant Klebsiella pneumoniae (CR Kp) entails stopping meropenem and adding tigecycline. Further creatinine clearance declined, and the drug Colistin was changed to Polymixin B. Meropenem was readministered based on the culture reports with scanty growth of multidrug-resistant Proteus mirabilis. Rational use of antibiotics along with the appropriate supportive measures is a meaningful measure in treating a rare and complicated condition of RHD with urosepsis.

Arteriovenous Malformation of the Tongue Resulting in Recurrent Severe Hemorrhage in a Young Dog

ABSTRACT An 8 mo old male entire beagle was presented to the emergency and critical care service following several severe bleeding episodes from the oral cavity. Oral examination revealed a purple, spongy, pulsatile lesion on the rostral two-thirds of the tongue. Computed tomography angiography revealed a severely distended right linguofacial vein with numerous, tortuous branching vessels within the tongue, consistent with an arteriovenous (AV) malformation. A cervical surgical approach was performed, and the right lingual artery was isolated and catheterized. A direct arteriogram confirmed this was the main feeder artery to the lesion, and it was ligated. Although the bleeding episodes initially resolved, a moderate bleeding episode occurred 6 days postoperatively, and a partial glossectomy was performed. Histopathology was consistent with an AV malformation. The dog had a good recovery from surgery and remains free of clinical signs 13 mo later. Following extensive review of the veterinary literature, this is the only reported case of a lingual AV malformation in the dog. Partial glossectomy resulted in resolution of the clinical signs and was well tolerated. Although rare, AV malformations should be considered as a differential diagnosis for spontaneous oropharyngeal bleeding.

Recurrent hemoptysis caused by arteriovenous malformation

Pulmonary arteriovenous malformation is a rare disorder of pulmonary vascularization. We are going to describe the case of recurring hemoptysis with a patient who was diagnosed late with pulmonary AV malformation. The 68-yearold patient was hospitalized for the fourth time in the Clinic for Pulmonology, Clinical Center of Kragujevac due to recurring hemoptysis. Bronchoscopy was conducted which showed no signs of bleeding nor new changes in the bronchial lumen. MSCT of the chest eliminated the possibility of bronchiectasis as the cause for hemoptysis. Chest MSCT was repeated, and it was without evolutionary aspect when compared to the previous one. In April 2019, at the Military Medical Academy in Belgrade, the patient had bronchoscopy performed, the results were normal, and the examination was completed with exploration, along with selective angiography, where AV shunt could be seen on the left side. Since the diameter of the left bronchial artery was less than 2 mm, it was not possible to place the micro-catheter and do embolization, but hemostasis was done by manual compression, which lasted for 10 minutes. After six months of follow-up examinations, no complications were registered with the patient. The method of choice for diagnosing PAV malformation is bronchial angiography, while other chest radiographic methods are not reliable. Embolization is the method of choice for treating this disorder.