Tuberc Respir Dis.  2015 Oct;78(4):408-411. 10.4046/trd.2015.78.4.408.

Successful Treatment of a Large Pulmonary Arteriovenous Malformation by Repeated Coil Embolization

• Park J
• Kim HJ
• Kim JM
• Park YS

• KMID: 2320716
• DOI: http://doi.org/10.4046/trd.2015.78.4.408

Abstract

Pulmonary arteriovenous malformations (AVMs) are caused by abnormal vascular communications between the pulmonary arteries and pulmonary veins, which lead to the blood bypassing the normal pulmonary capillary beds. Pulmonary AVMs result in right-to-left shunts, resulting in hypoxemia, cyanosis, and dyspnea. Clinical signs and symptoms vary depending on the size, number, and flow of the AVMs. Transcatheter embolization is the treatment of choice for pulmonary AVMs. However, this method can fail if the AVM is large or has multiple complex feeding arteries. Surgical resection is necessary in those kind of cases. Here, we report the case of a patient with a 6-cm pulmonary AVM with multiple feeding arteries that was successfully treated by repeated coil embolization without surgery.

Keyword

Arteriovenous Malformations; Embolization, Therapeutic; Pulmonary Artery; Pulmonary Veins

MeSH Terms

Anoxia
Arteries
Arteriovenous Malformations*
Capillaries
Cyanosis
Dyspnea
Embolization, Therapeutic*
Humans
Pulmonary Artery
Pulmonary Veins

Figure

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  Figure 1 Initial chest radiograph showing a mass-like opacity in the right lower lung field.

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  Figure 2 (A-D) Chest computed tomography showing a huge entangled enhanced lesion in the right middle lobe, which is consistent with pulmonary arteriovenous malformation (arrows).

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  Figure 3 Angiography visualizing a large pulmonary arteriovenous malformation with multiple complex feeding arteries (A). Transcatheter embolization was performed twice (B, C), and post-embolization chest radiography revealed radioopaque embolization materials (D).

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  Figure 4 (A, B) A 1-year follow-up computed tomography showing no evidence of recanalization, although the evaluation was limited due to the presence of artifacts (arrows).

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