Circulation. 1999;100:e29-e30
(Circulation. 1999;100:e29-e30.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
Pulmonary Arteriovenous Malformation
C. Andrew Brian, MD;
R. Mark Payne, MD;
Kerry M. Link, MD;
W. Gregory Hundley, MD;
James G. Warner, Jr, MD, EdD
From the Section of Cardiology (C.A.B., K.M.L., W.G.H., J.G.W.),
Department of Pediatrics (R.M.P.), and Division of Radiologic Sciences
(K.M.L., W.G.H.), Wake Forest University School of Medicine, Winston-Salem,
NC.
Correspondence to James G. Warner, Jr, MD, EdD, Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045. E-mail jwarner{at}wfubmc.edu
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Introduction
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A35-year-old white
woman with a history of migraine headaches
and a grade 2
systolic murmur presented with symptoms of slurred
speech,
left-sided facial droop, and left hemiparesis after a
hysterectomy.
These symptoms resolved over several days, and in an
effort
to identify a potential cardiac source of embolism, a
transesophageal
echocardiogram was performed. Findings
were consistent with
a right-to-left shunt, with
intravenous saline contrast entering
the left upper
pulmonary vein (Figure 1A
). An
MRI study of the
chest demonstrated a pulmonary arteriovenous
malformation (AVM)
in the left upper lobe (Figure 1B
). The
patient underwent pulmonary
angiography, which confirmed
the pulmonary AVM (Figure 2A
) and
also identified an additional AVM
in the left lower lung.
1 2 Multiple coils were placed to
obliterate both AVMs (Figure
2B
). The patient had no physical
examination evidence of Osler-Weber-Rendu
syndrome, and her
systolic murmur was absent after the coil
embolization. She was
asymptomatic at a 6-month follow-up visit.
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Figure 1. A, Multiplane transesophageal
echocardiogram demonstrating saline contrast entering left upper
pulmonary vein (LPV). LAA indicates left atrial appendage. B,
MRI demonstrating an AVM (arrow) in anterior region of left upper
lung.
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Figure 2. A, Pulmonary angiogram showing
pulmonary AVM in left upper lung. B, Multiple coils in place to
obliterate AVM in left upper lung.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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References
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Dines DE, Seward JB, Bernatz PE. Pulmonary
arteriovenous fistulas. Mayo Clin Proc. 1983;58:176–181.[Medline]
[Order article via Infotrieve]
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Burke CM, Safai C, Nelson DP, Raffin TA.
Pulmonary arteriovenous malformations: a critical update.
Am Rev Respir Dis. 1986;134:334–339.[Medline]
[Order article via Infotrieve]
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Introduction
References