Ichiki Yoshinobu, Kawasaki Junji, Hamatsu Takayuki, Suehiro Taketoshi, Koike Makiko, Tanaka Fumihiro, Sugimachi Keizo
Department of Chest Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan.
Department of Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan.
Int J Surg Case Rep. 2015;7C:54-7. doi: 10.1016/j.ijscr.2014.12.006. Epub 2014 Dec 12.
We herein describe a rare case of a pulmonary arteriovenous fistula (PAVF).
The patient was a 20-year-old asymptomatic female, admitted to our hospital because of an abnormal shadow in the right lung field on chest X-rays. Chest computed tomography (CT) revealed two nodules with well-defined margins in the right upper and lower lobes. Contrast-enhanced three-dimensional CT (3D-CT) revealed two enhanced solitary lung nodules which were connected with linear structures suggestive of feeding arteries and drainage veins, respectively. Based on these findings, we made a preoperative diagnosis of PAVF. We performed partial pulmonary resection of the right upper and lower lobes by video-assisted thoracoscopic surgery (VATS). The histopathological findings revealed small and medium-sized vascular channels composed of arteries with mild and irregularly thickened muscle walls and juxtaposed or seemingly anastomosing dilated veins. Based on these findings, a diagnosis of PAVF was confirmed. The patient had an uneventful postoperative course.
A PAVF is often associated with various complications, and pregnancy could be a risk factor for these complications because of the increase in the shunt fraction. Females with known PAVF should be maximally treated prior to becoming pregnant as complications of PAVF during pregnancy can have devastating consequences. Therefore, we thought that treatment should be recommended in this case in the event she might later choose to become pregnant.
Surgical resection using VATS for a limited number of ipsilateral isolated pulmonary arteriovenous fistulae is recommended due to its safety, low recurrence and low mortality rate.
我们在此描述一例罕见的肺动静脉瘘（PAVF）病例。
患者为一名20岁无症状女性，因胸部X线检查发现右肺野异常阴影而入院。胸部计算机断层扫描（CT）显示右上叶和下叶有两个边界清晰的结节。对比增强三维CT（3D-CT）显示两个强化的孤立性肺结节，分别与提示供血动脉和引流静脉的线性结构相连。基于这些发现，我们术前诊断为PAVF。我们通过电视辅助胸腔镜手术（VATS）对右上叶和下叶进行了部分肺切除术。组织病理学检查结果显示，由动脉组成的中小血管通道，肌壁轻度且不规则增厚，静脉扩张并置或看似吻合。基于这些发现，确诊为PAVF。患者术后恢复顺利。
PAVF常伴有各种并发症，由于分流分数增加，妊娠可能是这些并发症的一个危险因素。已知患有PAVF的女性在怀孕前应接受最大限度的治疗，因为怀孕期间PAVF的并发症可能会产生毁灭性后果。因此，我们认为如果该患者日后可能选择怀孕，本病例应建议进行治疗。
对于数量有限的同侧孤立性肺动静脉瘘，建议采用VATS进行手术切除，因其安全性高、复发率低且死亡率低。
