Akiyama Shintaro, Hanada Shigeo, Uruga Hironori, Takaya Hisashi, Miyamoto Atsushi, Morokawa Nasa, Kurosaki Atsuko, Fujii Takeshi, Kohno Tadasu, Kishi Kazuma
Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Japan.
Intern Med. 2013;52(10):1091-4. doi: 10.2169/internalmedicine.52.9186. Epub 2013 May 15.
A 67-year-old hypoxic woman was admitted following two episodes of cerebral infarction. Based on the clinical presentation and radiological findings, a diagnosis of hereditary hemorrhagic telangiectasia was made and the cerebral ischemic complications were considered to have been caused by paradoxical embolizations related to pulmonary arteriovenous malformations (PAVMs). We performed video-assisted thoracoscopic surgery (VATS) and identified turbulent thrombi in one of the PAVMs that were capable of circulating systemically and inducing embolic strokes. The condition of the patient improved immediately following VATS. This case suggests that VATS may be a preferred therapeutic option in the treatment of patients with PAVM accompanying recurrent episodes of life-threatening complications such as strokes.
一名67岁的缺氧女性在发生两次脑梗塞后入院。根据临床表现和影像学检查结果，诊断为遗传性出血性毛细血管扩张症，脑缺血并发症被认为是由与肺动静脉畸形（PAVM）相关的反常栓塞引起的。我们进行了电视辅助胸腔镜手术（VATS），并在其中一个PAVM中发现了可在全身循环并引发栓塞性中风的湍流血栓。VATS术后患者病情立即改善。该病例表明，对于伴有中风等危及生命并发症反复发作的PAVM患者，VATS可能是一种首选的治疗选择。
