Nakagawa Atsushi, Saito Hiroaki, Ryujinn Yasushi, Yoshimura Nobuyuki, Oosawa Hiroshi, Matsubara Osamu
Department of Respiratory Medicine, Hiratsuka Kyosai Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Jan;49(1):49-56.
A 57-year-old woman complaining of dyspnea on exertion and left back pain was admitted to our hospital. Chest X-ray films revealed a nodular lesion in the lower left lung field. Enhanced chest computed tomography (CT) scans demonstrated a nodular lesion communicating with a dilated pulmonary artery and vein in the subpleural region of the left S9. The presence of cutaneous telangiectases, repeated epistaxis and a family history of arteriovenous malformation (AVM) indicated a diagnosis of pulmonary AVM during a course of Rendu-Osler-Weber disease. Lobectomy of the left lower lung was performed. The AVM appeared to be located in the subpleural region of the left S9 on chest CT images. However, it was actually located in the left S9 and was protruding from the pleural surface. The wall of the AVM appeared very flimsy and was likely to rupture easily.
一名57岁女性因劳力性呼吸困难和左背部疼痛入院。胸部X线片显示左下肺野有一个结节性病变。胸部增强计算机断层扫描(CT)显示左S9胸膜下区域有一个与扩张的肺动脉和静脉相通的结节性病变。皮肤出现毛细血管扩张、反复鼻出血以及存在动静脉畸形(AVM)家族史提示在诊断为遗传性出血性毛细血管扩张症的过程中存在肺动静脉畸形。对左下肺进行了肺叶切除术。胸部CT图像显示动静脉畸形似乎位于左S9的胸膜下区域。然而,它实际上位于左S9且从胸膜表面突出。动静脉畸形的壁看起来非常薄弱,很容易破裂。