Endovascular Management of Pulmonary Arteriovenous Malformations Presenting As Multiple Brain Abscesses

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2022 Nov 22

PMID 36414347

Authors

Surya Nandan Prasad

Srishti Sharma

Vivek Singh

Rajendra Vishnu Phadke

Affiliations

Soon will be listed here.

Abstract

Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium. On radiological work-up, multiple brain abscesses and large PAVMs were evident. The patient was successfully treated by endovascular embolisation of the PAVMs using a vascular plug and multiple coils. The patient showed complete clinical recovery and resolution of brain abscesses on follow-up.

References

Andersen P, Kjeldsen A . Interventional treatment of pulmonary arteriovenous malformations. World J Radiol. 2010; 2(9):339-44. PMC: 2999335. DOI: 10.4329/wjr.v2.i9.339. View

Kjeldsen A, Oxhoj H, Andersen P, Green A, Vase P . Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT). J Intern Med. 2000; 248(3):255-62. DOI: 10.1046/j.1365-2796.2000.00725.x. View

Nam T, Park Y, Kwon J . Brain Abscesses Associated with Asymptomatic Pulmonary Arteriovenous Fistulas. J Korean Neurosurg Soc. 2017; 60(1):118-124. PMC: 5223758. DOI: 10.3340/jkns.2015.0707.023. View

Kuczynska M, Pyra K, Swiatlowski L, Sobstyl J, Kuklik E, Jargiello T . Endovascular embolisation strategies for pulmonary arteriovenous malformations. Pol J Radiol. 2019; 83:e189-e196. PMC: 6323602. DOI: 10.5114/pjr.2018.75838. View

Chamarthy M, Park H, Sutphin P, Kumar G, Lamus D, Saboo S . Pulmonary arteriovenous malformations: endovascular therapy. Cardiovasc Diagn Ther. 2018; 8(3):338-349. PMC: 6039801. DOI: 10.21037/cdt.2017.12.08. View

Meek M, Meek J, Beheshti M . Management of pulmonary arteriovenous malformations. Semin Intervent Radiol. 2012; 28(1):24-31. PMC: 3140246. DOI: 10.1055/s-0031-1273937. View

Li C, Hao S, Wang J, Gao Z, Ji N . Severe cerebral abscess associated with pulmonary arteriovenous fistula: case report and literature review. Chin Neurosurg J. 2020; 4:30. PMC: 7398252. DOI: 10.1186/s41016-018-0137-4. View

McDonald J, Bayrak-Toydemir P, DeMille D, Wooderchak-Donahue W, Whitehead K . Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasia is highly predictive of a pathogenic variant in ENG or ACVRL1 (HHT1 and HHT2). Genet Med. 2020; 22(7):1201-1205. DOI: 10.1038/s41436-020-0775-8. View

Vidjak V, Stula I, Matijevic F, Kavur L, Sertic Milic H, Blaskovic D . Embolisation of pulmonary arteriovenous malformations - case series. Pol J Radiol. 2019; 83:e326-e332. PMC: 6323544. DOI: 10.5114/pjr.2018.77695. View

10.

Sulaiman S, Vinayakumar D, Bastian C . Percutaneous closure of a giant pulmonary arteriovenous malformation using multiple devices. J Cardiol Cases. 2018; 16(2):62-65. PMC: 6149272. DOI: 10.1016/j.jccase.2017.04.009. View

11.

Tau N, Atar E, Mei-Zahav M, Bachar G, Dagan T, Birk E . Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia. Cardiovasc Intervent Radiol. 2016; 39(8):1110-4. DOI: 10.1007/s00270-016-1357-7. View

12.

Wu Z, Lin J, Yang W, Jiang N, Huang N, Clavijo L . Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations. BMC Pulm Med. 2021; 21(1):77. PMC: 7934521. DOI: 10.1186/s12890-021-01448-z. View