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[Pulmonary arteriovenous fistulas]
J Szopiński1, Z Kamiński, I Bestry
1III Kliniki Gruźlicy i Chorób Płuc.
Insights
Pulmonary arteriovenous fistulas (PAFs) are rare lung malformations. This case highlights PAFs presenting as hemoptysis, successfully treated with lobectomy.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Pulmonary arteriovenous fistulas (PAFs) are uncommon vascular malformations.
- PAFs are often congenital, associated with Osler-Weber-Rendu disease, but can be acquired.
- The Institute of Tuberculosis and Chest Diseases has observed 11 congenital PAF cases among 4000 resected lungs.
Observation:
- A 40-year-old male presented with hemoptysis, initially suspected as tuberculosis or cancer.
- Chest X-rays showed a right upper lobe infiltrate that progressed despite antitubercular treatment.
- Persistent, life-threatening hemoptysis prompted surgical intervention without prior angiography.
Findings:
- Right upper lobectomy revealed pulmonary arteriovenous fistulas in the resected lobe.
- The patient experienced complete symptom resolution post-surgery.
- Post-operative angiography was declined by the patient.
Implications:
- This case underscores the importance of considering PAFs in patients with unexplained hemoptysis and progressive lung infiltrates.
- Surgical resection can be an effective treatment for symptomatic PAFs, even in the absence of pre-operative diagnosis via angiography.
- Early recognition and management of PAFs are crucial for preventing potentially fatal hemorrhages.
Abstract:
Pulmonary arteriovenous fistulas are rare congenital malformations associated in 40% of cases with Osler-Weber-Rendu disease. PAF acquired in connection with the chest trauma, surgery and some inflammatory or neoplastic lung diseases were also described. In the Institute of Tuberculosis and Chest Diseases we have observed 11 cases of congenital PAF in 4000 resected lungs during the last years. In this report we described one more case with PAF. A 40 years old man was admitted to the Institute of Tuberculosis and Chest Diseases with hemoptysis. History and physical examination was unremarkable. Chest roentgenogram revealed a right upper lobe infiltrate. Tuberculosis or cancer was suspected and during the diagnostic procedures antituberculous drugs were given. After 3 weeks of treatment hemoptysis increased and chest roentgenogram revealed progression of the infiltrate in the right upper lobe and new lesions in the middle lobe. According to the character of X-ray progression which night be characteristic of active bleeding, a possibility of arteriovenous fistulas could not be excluded. As life threatening haemorrhage persisted right upper lobectomy without angiography was done. In the resected lobe arteriovenous fistulas were found. Angiography after operation was proposed but was refused by the patient. He is now well and symptoms free 5 months.