Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, 4-1-2, Tsubakimori, Chuo-ku, Chiba, 260-8606, Japan.
Department of Neurology, National Hospital Organization Chiba Medical Center, 4-1-2, Tsubakimori, Chuo-ku, Chiba, 260-8606, Japan.
J Cardiothorac Surg. 2021 Sep 8;16(1):258. doi: 10.1186/s13019-021-01644-2.
A pulmonary arteriovenous malformation is an abnormal dilated blood vessel that makes direct communication between a pulmonary artery and pulmonary vein and can be associated with hypoxemia or neurological complications, including brain abscess and cerebral infarction. Treatment of pulmonary arteriovenous malformation includes surgical resection and transcatheter embolotherapy, however the adaptation of therapies should be considered when a patient is in bad condition.
A 51-year-old man was admitted after developing fever, consciousness disorder, and hypoxemia. Magnetic resonance imaging of the brain showed a brain abscess. Bilateral pulmonary arteriovenous malformations were found by contrast computed tomography. Because of a family history of pulmonary arteriovenous malformation, a history of epistaxis, and the existence of oral mucosa telangiectasia, he was diagnosed with hereditary hemorrhagic telangiectasia and brain abscess caused by intrapulmonary right-to-left shunt. The brain abscess improved with antibiotic treatment; however, the administration of oxygen did not ameliorate his hypoxemia. His hypoxemia was exacerbated by positive pressure ventilation. Considering his systemic and respiratory condition, we considered surgery to involve a high degree of risk. After controlling his brain abscess and pneumonia, transcatheter embolotherapy was performed. This improved his systemic condition, enabling surgical treatment.
This middle-aged patient suffering from brain abscess and severe hypoxemia with multiple pulmonary arteriovenous malformations was successfully treated by a combination of transcatheter embolotherapy and surgery. The adaptation and combination of therapies, as well as the sequence of treatments, should be considered depending on the patient status and lesions.
肺动静脉畸形是一种异常扩张的血管，可导致肺动脉和肺静脉之间直接沟通，并可能与低氧血症或神经并发症相关，包括脑脓肿和脑梗死。肺动静脉畸形的治疗包括手术切除和经导管栓塞治疗，但当患者病情不佳时，应考虑治疗方法的适应性。
一名 51 岁男性因发热、意识障碍和低氧血症入院。脑部磁共振成像显示脑脓肿。对比增强计算机断层扫描发现双侧肺动静脉畸形。由于家族性肺动静脉畸形史、鼻出血史和口腔黏膜毛细血管扩张症，他被诊断为遗传性出血性毛细血管扩张症和由肺内右向左分流引起的脑脓肿。脑脓肿经抗生素治疗后改善；然而，吸氧并不能改善他的低氧血症。正压通气使他的低氧血症恶化。考虑到他的全身和呼吸系统状况，我们认为手术风险较高。在控制脑脓肿和肺炎后，进行了经导管栓塞治疗。这改善了他的全身状况，使手术治疗成为可能。
这名中年患者患有脑脓肿和严重低氧血症，伴有多发肺动静脉畸形，通过经导管栓塞治疗和手术联合治疗获得成功。应根据患者的状况和病变考虑治疗方法的适应性和组合，以及治疗的顺序。
