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Pulmonary arteriovenous malformation: An unusual cause of hemothorax.

Gupta ML, Gupta M, Vijay DK, Bagarhatta R - Lung India (2015 Nov-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Diseases and Tuberculosis, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. E-mail: drmanohargupta@gmail.com.

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In view of the presence of clubbing with hemothorax, closed pleural biopsy was performed with Abrams needle with aspiration of remaining pleural fluid... Histopathological examination of pleural biopsy was not conclusive... Therefore, multidetector computed tomography (MDCT) thorax angiography was performed to confirm PAVM and to delineate the number and size of the feeders... Hemothorax as a presenting feature of PAVM is a very rare occurrence... Ali et al. found only 32 reported cases of hemothorax associated with PAVM till 2008... Conventional pulmonary angiography and MDCT thoracic angiography were the two options before us to confirm the diagnosis of PAVM in this patient... Pulmonary angiography and MDCT angiography chest both have their own merits and demerits... MDCT thoracic angiography was preferred as it is superior in demonstrating small arteriovenous malformations, non-invasive and relatively inexpensive than conventional pulmonary angiography... But, vascular lesions may also give false positive result on this modality... Contrast-enhanced MR angiography has also been found to be more sensitive than pulmonary angiography in detecting PAVM... Further, although contrast enhanced MR angiography has the advantage of acquiring MIP reconstructions of complex PAVM in multiple planes but it is inferior in delineating lung parenchymal pathology as compared to MDCT angiography... Risk of future recurrence and the presence of a single malformation tilted the balance in favor of surgical excision of the lesion... Video-assisted thoracoscopic wedge resection was performed as it is associated with less morbidity and mortality than conventional thoracotomy.

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Related in: MedlinePlus

MDCT angiography volume rendered image showing a lobulated vascular malformation with a single feeding vessel originating from pulmonary artery and a single draining vein
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Figure 3: MDCT angiography volume rendered image showing a lobulated vascular malformation with a single feeding vessel originating from pulmonary artery and a single draining vein

Mentions: CECT and echocardiography findings favoured a strong possibility of pulmonary arterio venous malformation (PAVM). Therefore, multidetector computed tomography (MDCT) thorax angiography was performed to confirm PAVM and to delineate the number and size of the feeders. MDCT angiography showed a lobulated vascular mass of 25.7 mm × 13.8 mm in right anterior lower chest with a single feeder vessel of 5.5-mm diameter. Efferent was seen draining right inferior pulmonary vein [Figures 2 and 3]. In view of a single PAVM with a feeder vessel of 5.5 mm in diameter, patient was referred to thoracic surgeon. Video-assisted thoracoscopic wedge resection of malformation was done with ligation of the feeder. Postoperatively patient had favorable recovery with normalization of his resting SpO2 and was doing well till the fourth week of follow-up.


Pulmonary arteriovenous malformation: An unusual cause of hemothorax.

Gupta ML, Gupta M, Vijay DK, Bagarhatta R - Lung India (2015 Nov-Dec)

MDCT angiography volume rendered image showing a lobulated vascular malformation with a single feeding vessel originating from pulmonary artery and a single draining vein
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663881&req=5

Figure 3: MDCT angiography volume rendered image showing a lobulated vascular malformation with a single feeding vessel originating from pulmonary artery and a single draining vein
Mentions: CECT and echocardiography findings favoured a strong possibility of pulmonary arterio venous malformation (PAVM). Therefore, multidetector computed tomography (MDCT) thorax angiography was performed to confirm PAVM and to delineate the number and size of the feeders. MDCT angiography showed a lobulated vascular mass of 25.7 mm × 13.8 mm in right anterior lower chest with a single feeder vessel of 5.5-mm diameter. Efferent was seen draining right inferior pulmonary vein [Figures 2 and 3]. In view of a single PAVM with a feeder vessel of 5.5 mm in diameter, patient was referred to thoracic surgeon. Video-assisted thoracoscopic wedge resection of malformation was done with ligation of the feeder. Postoperatively patient had favorable recovery with normalization of his resting SpO2 and was doing well till the fourth week of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Chest Diseases and Tuberculosis, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. E-mail: drmanohargupta@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In view of the presence of clubbing with hemothorax, closed pleural biopsy was performed with Abrams needle with aspiration of remaining pleural fluid... Histopathological examination of pleural biopsy was not conclusive... Therefore, multidetector computed tomography (MDCT) thorax angiography was performed to confirm PAVM and to delineate the number and size of the feeders... Hemothorax as a presenting feature of PAVM is a very rare occurrence... Ali et al. found only 32 reported cases of hemothorax associated with PAVM till 2008... Conventional pulmonary angiography and MDCT thoracic angiography were the two options before us to confirm the diagnosis of PAVM in this patient... Pulmonary angiography and MDCT angiography chest both have their own merits and demerits... MDCT thoracic angiography was preferred as it is superior in demonstrating small arteriovenous malformations, non-invasive and relatively inexpensive than conventional pulmonary angiography... But, vascular lesions may also give false positive result on this modality... Contrast-enhanced MR angiography has also been found to be more sensitive than pulmonary angiography in detecting PAVM... Further, although contrast enhanced MR angiography has the advantage of acquiring MIP reconstructions of complex PAVM in multiple planes but it is inferior in delineating lung parenchymal pathology as compared to MDCT angiography... Risk of future recurrence and the presence of a single malformation tilted the balance in favor of surgical excision of the lesion... Video-assisted thoracoscopic wedge resection was performed as it is associated with less morbidity and mortality than conventional thoracotomy.

No MeSH data available.


Related in: MedlinePlus