scholarly journals A case of dyspnea: respiratory failure due to pulmonary arteriovenous malformation

2019 ◽  
Vol 13 (4) ◽  
pp. 244-246
Author(s):  
Lucio Brugioni ◽  
Chiara Catena ◽  
Eugenio Ferraro ◽  
Serena Scarabottini ◽  
Francesca Mori ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Respiratory Failure ◽  
General Population ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Pulmonary Nodules ◽  
Pulmonary Arteriovenous Malformations ◽  
Angio Ct ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and veins. The clinical features suggestive of PAVMs are stigmata of right-to-left shunting (dyspnea, hypoxemia, cyanosis, cerebral embolism, brain abscess), unexplained hemoptysis, or hemothorax.We present a case of young man presented to Emergency Department complaining dyspnea, polycythemia and persistent hypoxemia. Angio-CT scan of the chest detected multiple PAVMs.PAVMs are uncommon in the general population, but they are an important consideration in the differential diagnosis of common pulmonary problems, including hypoxemia, pulmonary nodules, and hemoptysis

scholarly journals Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update

2020 ◽  
Vol 9 (6) ◽  
pp. 1927 ◽  
Author(s):  
Shamaita Majumdar ◽  
Justin P. McWilliams
Keyword(s):  
Chest Pain ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Gold Standard ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Clinical Manifestations ◽  
High Flow ◽  
Pulmonary Arteriovenous Malformations ◽  
Institutional Experience ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are abnormal direct vascular communications between pulmonary arteries and veins which create high-flow right-to-left shunts. They are most frequently congenital, usually in the setting of hereditary hemorrhagic telangiectasia (HHT). PAVMs may be asymptomatic or present with a wide variety of clinical manifestations such as dyspnea, hypoxemia, or chest pain. Even when asymptomatic, presence of PAVMs increases patients’ risk of serious, potentially preventable complications including stroke or brain abscess. Transcatheter embolotherapy is considered the gold standard for treatment of PAVMs. Though previous guidelines have been published regarding the management of PAVMs, several aspects of PAVM screening and management remain debated among the experts, suggesting the need for thorough reexamination of the current literature. The authors of this review present an updated approach to the diagnostic workup and management of PAVMs, with an emphasis on areas of controversy, based on the latest literature and our institutional experience.

scholarly journals Surgical lobectomy of pulmonary arteriovenous malformations in a patient with presentations regarded as sequela of tuberculosis: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peng Teng ◽  
Weidong Li ◽  
Yiming Ni
Keyword(s):  
Oxygen Saturation ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Bone Marrow Aspiration ◽  
Pulmonary Angiography ◽  
Pulmonary Arteriovenous Malformations ◽  
Low Oxygen ◽  
Case Presentation ◽  
Digital Clubbing ◽  
Arteries And Veins

Abstract Background Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions. Case presentation We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86 to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl 3 months after surgery and the patient had been followed up for nearly 5 years. Conclusions Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations.

scholarly journals Surgical Lobectomy of Pulmonary Arteriovenous Malformations in a Patient with Presentations Regarded as Sequela of Tuberculosis: A Case Report

2020 ◽  
Author(s):  
Peng Teng ◽  
Weidong Li ◽  
Yiming Ni
Keyword(s):  
Oxygen Saturation ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Bone Marrow Aspiration ◽  
Pulmonary Angiography ◽  
Pulmonary Arteriovenous Malformations ◽  
Low Oxygen ◽  
Case Presentation ◽  
Digital Clubbing ◽  
Arteries And Veins

Abstract Background: Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions.Case presentation: We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86% to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl three months after surgery and the patient had been followed up for nearly 5 years.Conclusions: Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations.

Pulmonary Arteriovenous Malformations

2018 ◽  
pp. 315-324
Author(s):  
Jeffrey S. Pollak
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Vascular Lesions ◽  
Common Symptom ◽  
Pulmonary Arteriovenous Malformations ◽  
Capillary Bed ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are dilated directly, connecting pulmonary arteries and veins with no capillary bed. They are generally congenital and frequently occur in patients with autosomal-dominant hereditary hemorrhagic telangiectasia (HHT), so they should be screened for PAVM. HHT causes variable-sized arteriovenous malformations (AVMs) from telangiectases to larger connections and affects mucocutaneous surfaces. Epistaxis is the most common symptom, and these vascular lesions can occur in other organs, including the lungs, central nervous system, liver, and gastrointestinal (GI) tract. PAVMs can result in hypoxemia with dyspnea, paradoxical embolization with ischemic stroke and abscess formation, and hemorrhage. Treatment consists of embolization of sufficiently sized lesions; antibiotic prophylaxis before procedures prone to produce bacteremia, such as dental processes that can cause abscesses; and avoidance of air or clots in intravenous (IV) lines. Lifelong follow-up is essential to assess for adequacy of embolization and enlargement of PAVMs that are too small to embolize.

scholarly journals A case of Multiple Unilateral Pulmonary arteriovenous Malformation Relapse: Efficacy of embolization treatment

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Rossella Masiello ◽  
Carlo Iadevaia ◽  
Edoardo Grella ◽  
Carmelindo Tranfa ◽  
Francesco Cerqua ◽  
...  
Keyword(s):  
Bronchial Artery ◽  
Pulmonary Arteries ◽  
Clinical Manifestations ◽  
Transcatheter Embolization ◽  
Functional Improvement ◽  
Embolization Treatment ◽  
Angio Ct ◽  
Vascular Alteration ◽  
Arteries And Veins ◽  
Ischemic Events

Abstract Pulmonary arteriovenous Malformations (PAVMs) are a rare vascular alteration characterized by abnormal communications between the pulmonary arteries and veins resulting in an extracardiac right-to-left (R-L) shunt. The majority of PAVMs are associated with an autosomal dominant vascular disorder also known as Osler-Weber- Rendu Syndrome. PAVMs appearance can be both single and multiple. Clinical manifestations include hypoxemia, dyspnea cyanosis, hemoptysis and cerebrovascular ischemic events or abscesses. We report a case of an 18 year old female with severe respiratory failure caused by a relapse of multiple unilateral pulmonary arterovenous fistula. Symptoms at admission include dyspnea, cyanosis and clubbing. The patient underwent pulmonary angio-TC scan, brain CT and echocardiography. The thoracic angio-CT scan showed the presence of PAVMs of RUL and RLL; a marked increase of right bronchial artery caliber and its branches with an aneurismatic dilatation was also observed. The patient underwent percutaneous transcatheter embolization using Amplatzer Vascular Plug IV; a relevant clinical and functional improvement was subsequently recorded. Embolization is effective in the treatment of relapsing PAVMS.

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 Pulmonary Arteriovenous Malformations Incidentalloma in a 10-Years-Old Child

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110511
Author(s):  
Daoud Ali Mohamed ◽  
Amarkak Waiss ◽  
Behyamet Onka ◽  
Walid Mohamed ◽  
Nazik Allali ◽  
...  
Keyword(s):  
Risk Factor ◽  
Arteriovenous Malformations ◽  
Pulmonary Veins ◽  
Pulmonary Arteries ◽  
Clinical Manifestations ◽  
Pulmonary Arteriovenous Malformations ◽  
Variable Range ◽  
Age Of Diagnosis ◽  
Refractory Hypoxemia ◽  
Capillary Bed

Pulmonary Arteriovenous Malformations (PAVMs) are structurally abnormal vascular communications between pulmonary arteries and pulmonary veins, which bypass the normal capillary bed and cause a low resistance right-to-left shunt with refractory hypoxemia. Generally, PAVMs were congenital, most commonly associated with (Hereditary hemorrhagic teleangiectasia (HHT). The age of diagnosis is very variable, range neonatal to adulthood, mostly diagnosed in the first 3 decades of life and clinical manifestations occur later in life generally. Here, we report PAVMs discovered incidentally in a 10-years-old child without any known risk factor.

scholarly journals An undiagnosed myasthenia gravis presenting as isolated recurrent acute respiratory failure

2012 ◽  
Vol 03 (01) ◽  
pp. 80-82
Author(s):  
Ram Shri Sharma ◽  
Nalini Sharma ◽  
ME Yeolekar
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Critical Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Myasthenia Gravis ◽  
Care Setting ◽  
Signs And Symptoms ◽  
Initial Presentation ◽  
Speech Therapist

ABSTRACTAcute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider MG in the differential diagnosis of an otherwise unexplained respiratory failure in the critical care setting.

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