101
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Gan F, Vikneswaran V, Yu KK. Uterine arteriovenous malformation - Possible association to uterine fibroids? Med J Malaysia 2021; 76:273-274. [PMID: 33742646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.
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Affiliation(s)
- F Gan
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia.
| | - V Vikneswaran
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia
| | - K K Yu
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia
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Nagata K, Tajiri K, Muraishi N, Kobayashi S, Sibuya K, Yoshioka I, Fujii T, Tanaka S, Imura J, Yasuda I. A case of pancreatic arteriovenous malformation caused acute pancreatitis. Clin J Gastroenterol 2021; 14:364-369. [PMID: 32955705 DOI: 10.1007/s12328-020-01231-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
Arteriovenous malformation (AVM) in the pancreas rarely causes acute pancreatitis. However, even when it does cause pancreatitis, the pathogenesis is unclear. A 61-year-old man was admitted to our hospital for acute pancreatitis. The findings of computed abdominal tomography, magnetic resonance imaging, and endoscopic ultrasonography revealed pancreatic AVM and hematoma in the tail of the pancreas. These lesions were suspected to be associated with pancreatitis. Although endoscopic retrograde pancreatography could not confirm hemosuccus pancreaticus, distal pancreatectomy was performed because of repeated pancreatitis. The histopathological findings of the resected specimen revealed rupture of the AVM vessels into the main pancreatic ducts. Finally, we considered that intermittent bleeding due to AVM rupture and hematoma formation in the main pancreatic duct caused the repeated pancreatitis.
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Affiliation(s)
- Kohei Nagata
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kazuto Tajiri
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Nozomu Muraishi
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Saito Kobayashi
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kazuto Sibuya
- Second Department of Surgery, University of Toyama, Toyama, Japan
| | - Isaku Yoshioka
- Second Department of Surgery, University of Toyama, Toyama, Japan
| | - Tsutomu Fujii
- Second Department of Surgery, University of Toyama, Toyama, Japan
| | - Shinichi Tanaka
- Department of Diagnostic Pathology, University of Toyama, Toyama, Japan
| | - Johji Imura
- Department of Diagnostic Pathology, University of Toyama, Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Cant A, Van Holsbeeck A, Vantomme N, Libbrecht N. Thoracolumbar spinal arteriovenous shunt as a rare cause of thunderclap headache in a young man. Acta Neurol Belg 2021; 121:275-278. [PMID: 33400224 DOI: 10.1007/s13760-020-01579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Antonin Cant
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium.
| | | | | | - Niels Libbrecht
- Department of Neurology, AZ Sint-Lucas Brugge, Bruges, Belgium
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Shimohira M, Kiyosue H, Osuga K, Gobara H, Kondo H, Nakazawa T, Matsui Y, Hamamoto K, Ishiguro T, Maruno M, Sugimoto K, Koganemaru M, Kitagawa A, Yamakado K. Location of embolization affects patency after coil embolization for pulmonary arteriovenous malformations: importance of time-resolved magnetic resonance angiography for diagnosis of patency. Eur Radiol 2021; 31:5409-5420. [PMID: 33449178 DOI: 10.1007/s00330-020-07669-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. METHODS Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. CONCLUSIONS TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. KEY POINTS • Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. • The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. • The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.
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Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Hiro Kiyosue
- Department of Radiology, Oita University, Yufu, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Diagnostic Radiology, Osaka Medical College, Takatsuki, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan
| | - Tetsuro Nakazawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Diagnostic Imaging, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Kohei Hamamoto
- Department of Radiology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Tomoya Ishiguro
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan
| | - Miyuki Maruno
- Department of Radiology, Oita University, Yufu, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Akira Kitagawa
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
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105
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Zhang G, Shi F. Non-adjacent Sacral Dural Arteriovenous Fistula and Thoracolumbar Spinal Arteriovenous Malformation. J Coll Physicians Surg Pak 2021; 31:117-118. [PMID: 33546551 DOI: 10.29271/jcpsp.2021.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/09/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Guiyun Zhang
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Shi
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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106
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Buntrock A, Hansen K, Peck S, Von Wald T. A Case of Uterine Arteriovenous Malformation Treated With Uterine Artery Embolization. S D Med 2021; 74:14-16. [PMID: 33691051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Uterine arteriovenous malformation (AVM) is a rare condition that is potentially life-threatening. There are limited published reports on this condition. This is a case report of a 25-year-old woman who presented with a symptomatic AVM. We review the differential diagnoses, evaluation, and treatment options. Conservative treatment with interventional radiology can be considered in select women who desire fertility preservation.
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Affiliation(s)
- Ahna Buntrock
- University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
| | - Keith Hansen
- Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota
- Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Shannon Peck
- Sanford Interventional Radiology, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tiffany Von Wald
- Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota
- Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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107
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Hou K, Xu K, Chen X, Wang Y, Li K, Yu J. Endovascular treatment for the flow-related aneurysm originating from an anterior inferior cerebellar artery supplying the cerebellar arteriovenous malformation. Interv Neuroradiol 2020; 26:566-574. [PMID: 32842831 PMCID: PMC7645184 DOI: 10.1177/1591019920954082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND When a flow-related aneurysm originates from an anterior inferior cerebellar artery (AICA) supplying the cerebellar arteriovenous malformation (AVM), the management becomes very complicated. Endovascular treatment (EVT) was an option, but no consensus has been achieved.Methods and materials: A retrospective investigation was performed for patients with flow-related aneurysm originating from an AICA supplying the cerebellar AVM. RESULTS Ten patients, harboring 13 aneurysms, were identified. Of the 5 a1 aneurysms, 2 underwent stent assisted coiling, 2 underwent parent artery occlusion (PAO), and 1 was intact. Of the 8 a2 aneurysms, 3 underwent coiling with preservation of the AICA, 3 underwent PAO with Onyx, 1 underwent PAO with coils, and 1 was intact. Seven patients underwent partial embolization of the cerebellar AVM, 3 were intact. One patient died 6 hours postoperatively for cerebellar AVM rebleeding. During a follow-up from 6 months to 6 years, 9 patients had favorable recovery. CONCLUSION For the flow-related aneurysm originating from an AICA supplying the cerebellar AVM, the EVT depends on the specific circumstances. When the aneurysm is located at the a1 segment, coiling of the aneurysm with preservation of the parent AICA should be performed. PAO is the last resort. When the a2 aneurysm is proximal to the internal auditory artery, coiling of the aneurysm with preservation of the AICA is preferred. When the aneurysm is distal to the internal auditory artery, PAO can be safely performed.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yiheng Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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108
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Huf VI, Fellner C, Wohlgemuth WA, Stroszczynski C, Schmidt M, Forman C, Wetzl J, Uller W. Fast TWIST with iterative reconstruction improves diagnostic accuracy of AVM of the hand. Sci Rep 2020; 10:16355. [PMID: 33004952 PMCID: PMC7529883 DOI: 10.1038/s41598-020-73331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/14/2020] [Indexed: 11/08/2022] Open
Abstract
Very high temporal and spatial resolution is mandatory for the diagnosis of arteriovenous malformations (AVM) of the hand. Until now, magnetic resonance imaging (MRI) has not fulfilled both requirements simultaneously. This study presents how the combination of a very fast TWIST MRI (time-resolved angiography with interleaved stochastic trajectories) sequence and iterative reconstructions optimizes temporal as well as spatial resolution. 11 patients were examined at a 3-T MRI scanner with two different TWIST protocols: the standard and the study protocol, acquiring a data set every 5.57 s and 1.44 s respectively. The study data was retrospectively iteratively reconstructed with different regularization factors (0.001, 0.002, 0.004, 0.008). Results were compared using the sign-test. P-values < 0.05 were regarded statistically significant. With a low amount of contrast medium, the temporal resolution of the study protocol enabled the differentiation of arteries from veins in all patients whereas the signal-to-noise ratio (SNR) deteriorated. Depending on the regularization factors, SNR, delineation of arterial feeders and non-involved hand and interdigital arteries, as well as artefact levels varied. Overall, iterative reconstruction with regularization factor 0.004 achieved the best results, consequently showing the ability of MRI as a reliable diagnostic method in AVMs of the hand.
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Affiliation(s)
- Veronika I Huf
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - Claudia Fellner
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - Walter A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, 06120, Halle (Saale), Germany
| | | | | | | | - Jens Wetzl
- Siemens Healthcare, 91052, Erlangen, Germany
| | - Wibke Uller
- Department of Radiology, University Medical Center Regensburg, 93042, Regensburg, Germany
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109
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El Sanharawi I, Barral M, Lenck S, Dillinger JG, Salvan D, Mangin G, Cogo A, Bailliart O, Levy BI, Kubis N, Bisdorff-Bresson A, Bonnin P. Wall Shear Stress in the Feeding Native Conduit Arteries of Superficial Arteriovenous Malformations of the Lower Face is a Reliable Marker of Disease Progression. Ultraschall Med 2020; 41:428-438. [PMID: 30321881 DOI: 10.1055/a-0729-2728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the prognostic value of the wall shear stress (WSS) measured in the feeding native arteries upstream from facial superficial arteriovenous malformations (sAVMs). Reliable prognostic criteria are needed to distinguish progressive from stable sAVMs and thus support the indication for an aggressive or a conservative management to avoid severe facial disfigurement. MATERIALS AND METHODS We prospectively included 25 patients with untreated facial sAVMs, 15 patients with surgically resected sAVMs and 15 controls. All had undergone Doppler ultrasound examination (DUS) with measurements of inner diameters, blood flow velocities, computation of blood flow and WSS of the feeding arteries. Based on the absence or presence of progression in clinical and imaging examinations 6 months after, we discriminated untreated patients as stable or progressive. RESULTS WSS in the ipsilateral external carotid artery was higher in progressive compared to stable sAVMs (15.8 ± 3.3dynes/cm² vs. 9.6 ± 2.0dynes/cm², mean±SD, p < 0.0001) with a cut-off of 11.5dynes/cm² (sensitivity: 92 %, specificity: 92 %, AUC: 0.955, [95 %CI: 0.789-0.998], p = 0.0001). WSS in the ipsilateral facial artery was also higher in progressive compared to stable sAVMs (50.7 ± 14.5dynes/cm² vs. 25.2 ± 7.1dynes/cm², p < 0.0001) with a cut-off of 34.0dynes/cm² (sensitivity: 100 %, specificity: 92 %, AUC: 0.974, [95 %CI: 0.819-1.000], p = 0.0001). The hemodynamic data of operated patients were not different from those of the control group. CONCLUSION WSS measured in the feeding arteries of an sAVM may be a simple reliable criterion to distinguish stable from progressive sAVMs. This value should be considered to guide the therapeutic strategy as well as the long-term follow-up of patients with facial sAVMs.
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Affiliation(s)
- Imane El Sanharawi
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | | | - Stéphanie Lenck
- APHP, Neuroradiology, center for arteriovenous malformations in children and adults, Lariboisiere Hospital, Paris, France
| | | | - Didier Salvan
- APHP, Otorhinolaryngology and maxillofacial surgery, Lariboisiere Hospital, Paris, France
| | | | - Adrien Cogo
- UMR965, CART, INSERM, Lariboisiere Hospital, Paris, France
| | - Olivier Bailliart
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | - Bernard I Levy
- Lariboisiere Hospital, Vessel and Blood Institut, Paris, France
| | - Nathalie Kubis
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
| | - Annouk Bisdorff-Bresson
- APHP, Neuroradiology, center for arteriovenous malformations in children and adults, Lariboisiere Hospital, Paris, France
| | - Philippe Bonnin
- APHP, Clinical Physiology - Functional Investigations, Lariboisiere Hospital, Paris, France
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Li X, Sun W, Chen L, Jin M, Zhang Z, Gao J, Fei X. Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: A case report and literature review. Medicine (Baltimore) 2020; 99:e21432. [PMID: 32756152 PMCID: PMC7402736 DOI: 10.1097/md.0000000000021432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging. PATIENT CONCERNS We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment. DIAGNOSES A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging. INTERVENTIONS Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident. OUTCOMES The fertility of the patient was preserved and hysterectomy was avoided. CONCLUSION Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.
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Affiliation(s)
- Xiangjuan Li
- Department of Female Pelvic Medicine and Reconstructive Surgery
| | | | | | - Mei Jin
- Department of Female Pelvic Medicine and Reconstructive Surgery
| | | | - Jiansong Gao
- Department of Ultrasonography, Hangzhou Women's Hospital, Hangzhou, China
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, St John's Medical College Hospital, Bangalore, India
| | - Dhilip Andrew
- Department of Radiology, St John's Medical College Hospital, Bangalore, India
| | - Jovis Johny
- Department of Radiology, St John's Medical College Hospital, Bangalore, India
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112
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Qiu S, Wei X, Hu H, Zhao X, Wen X, Zhong LM. Superselective Arterial Embolization of Arteriovenous Malformation of Internal Pudendal Artery, a Rare Cause of Hematuria: A Case Report. Am J Mens Health 2020; 14:1557988320923913. [PMID: 32865100 PMCID: PMC7466900 DOI: 10.1177/1557988320923913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Arteriovenous malformation (AVM) is a common form of vascular malformation, an abnormal direct communication between an artery and a vein without passing through the capillaries. AVM may just present as hematuria without plain or other symptoms. The article presents a case of a 52-year-old male with gross hematuria diagnosed as AVM of internal pudendal artery, which was successfully managed with superselective arterial embolization using temporary embolization materials.
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Affiliation(s)
- Shixiang Qiu
- School of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xin Wei
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Hong Hu
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xiaowei Zhao
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Xiaoxia Wen
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
| | - Li-Ming Zhong
- Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, Nanchong, Sichuan Province, P.R. China
- Li-Ming Zhong, Professor, Chief Physician, Department of Interventional Radiology, Central Hospital of Nanchong, The Second Clinical School of North Sichuan Medical College, 97 Renmin South Road, Central Hospital of Nanchong, Nanchong, Sichuan Province 637000, P.R. China.
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113
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Ferreras D, Ruiz de Angulo D, Sánchez Bueno F. Gastrointestinal bleeding in a pancreatic arteriovenous malformation successfully treated by transarterial embolization. Rev Esp Enferm Dig 2020; 112:505-506. [PMID: 32379477 DOI: 10.17235/reed.2020.6518/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pancreatic arteriovenous malformation (PAVM) is a rare case of upper gastrointestinal bleeding (UGIB), but it must be recognized in clinical practice, as it may be a potentially lethal condition in case of rupture and haemorrhage. This anatomic alteration is extremely rare as less than a hundred cases are reported in the scientific literature. The aim of this work is to report a case of PAVM presented as upper gastrointestinal bleeding (UGIB) and successfully treated by transarterial embolization.
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Affiliation(s)
- David Ferreras
- Cirugía General y del Aparato Dige, Hospital Universitario Virgen de la Arrixaca
| | - David Ruiz de Angulo
- Cirugía General y del Aparato Dige, Hospital Clinico Universitario Virgen de la Arrixaca, ESPAÑA
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114
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Vuillemin N, Bernhard S, Haine A, Schindewolf M, Häberli D, Hügel U, Obrist D, Baumgartner I. Capillary-venule malformation is a microfistulous variant of arteriovenous malformation. J Vasc Surg Venous Lymphat Disord 2020; 9:220-225. [PMID: 32470616 DOI: 10.1016/j.jvsv.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe typical clinical presentation of patients with microfistular, capillary-venule (CV) malformation as a variant form of arteriovenous malformations (AVM). METHODS A retrospective clinical analysis of 15 patients with CV-AVM confirmed by a computational flow model enrolled in a prospective database of patients with congenital vascular malformation between January 2008 and May 2018. RESULTS The mean age of the patients at first time of presentation was 30 years with balanced sex ratio. Presentation was dominated by soft tissue hypertrophy (n = 12 [80.0%]) and atypical varicose veins (n = 11 [73.3%]). The anatomic location of enlarged varicose veins gave no uniform pattern and did not correspond with the typical picture of primary varicose vein disease. Most often, symptomatic CV-AVM was found at the lower extremities in this series of unselected patients. The most frequent compartment affected was the subcutis (n = 14 [93.3%]), involvement of muscle was recorded in one-third and cutis in one-fourth of patients. CONCLUSIONS A high grade of clinical suspicion is needed to recognize CV-AVM and to prevent inadequate therapy owing to missed diagnosis.
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Affiliation(s)
- Nicolas Vuillemin
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel Haine
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dario Häberli
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ulrike Hügel
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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115
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Eichberg DG, Komotar RJ, Urakov TM. Commentary: Posterior C2-6 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E140-E141. [PMID: 32047933 DOI: 10.1093/ons/opaa006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/15/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Timur M Urakov
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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116
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Kishino M, Nishida K, Kimura K, Takahashi M, Nakaminato S, Kume H, Uchiyama H, Kudo T, Kawada S, Mori K, Tateishi U. Paravesical space arteriovenous malformation as a specific subgroup of pelvic vascular anomaly: a case series and review of literature. Jpn J Radiol 2020; 38:434-439. [PMID: 32043235 DOI: 10.1007/s11604-020-00924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/25/2020] [Indexed: 11/27/2022]
Abstract
Treatment of pelvic arteriovenous malformations (AVMs) is frequently challenging because of the complex structures and anatomical diversity among cases. We present a case series of six patients with pelvic AVMs. All patients had a similar anatomical structure consisting of multiple feeders from the unilateral internal iliac artery, collecting into a dilated venous sac in the unilateral paravesical space and draining into a single outflow, eventually joining the pre-prostatic vein or internal iliac vein. Five among these patients were successfully treated by catheter-directed embolo-sclerotherapy. In addition to our six cases, we identified six previous case reports of pelvic AVM with similar anatomical characteristics. Herein, we summarize the clinical and anatomical features of these 12 paravesical AVM cases. In all cases, the patients were men; the AVM was predominantly located at the right paravesical space and demonstrated good therapeutic effect of catheter-directed embolosclerotherapy. These paravesical AVMs may constitute a new subgroup of pelvic vascular anomalies with the same etiology that are treatable by adequate catheter intervention.
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Affiliation(s)
- Mitsuhiro Kishino
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Kenji Nishida
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Marie Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuichiro Nakaminato
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroko Kume
- Department of Vascular Surgery, Moriya Keiyu Hospital, Moriya, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Toshifumi Kudo
- Department of Vascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Kawada
- Department of Diagnostic Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Kouichi Mori
- Department of Diagnostic Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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117
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Abstract
Imaging studies of the hands and fingers are common, and radiologists are generally comfortable with traumatic and degenerative conditions which arise frequently in daily practice. However, a variety of common and uncommon soft-tissue tumors also occur in the hand, the appropriate diagnosis of which can be a source of confusion for both clinicians and radiologists. These lesions often have overlapping imaging characteristics; however, a structured approach can help provide a focused differential diagnosis and impact further workup and management. We discuss several such tumors, categorizing them as cystic-appearing, noncystic masses along tendons and aponeuroses, adipocytic tumors, vascular lesions, and miscellaneous lesions with imaging features that can aid diagnosis.
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Affiliation(s)
| | - Jeffrey Bonham
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Anthony Chang
- Department of Radiology, Sharp Rees Stealy Medical Group, San Diego, CA, USA
| | - Stephen Thomas
- Department of Radiology, University of Chicago, Chicago, IL, USA
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118
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Perfiliyev AM, Kiselev VS, Chishchina NV, Rzayev DA. [Endovascular embolization of spinal intramedullary arteriovenous malformation at the cervical level: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2020; 84:82-87. [PMID: 32649817 DOI: 10.17116/neiro20208403182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a successful endovascular treatment of complex arteriovenous malformation of the spinal cord at the cervical level. The strategy, technical aspects and the main principles of embolization of arteriovenous malformation are considered in the article.
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Affiliation(s)
| | - V S Kiselev
- Federal Center for Neurosurgery, Novosibirsk, Russia
| | | | - D A Rzayev
- Federal Center for Neurosurgery, Novosibirsk, Russia
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119
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Hanke I, Maršík L, Chovanec V, Slanina M, Koblížek V. Pulmonary arteriovenous malformation managed by VATS lobectomy. Rozhl Chir 2020; 99:467-471. [PMID: 33242965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pulmonary arteriovenous malformation (PAVM) is formed by abnormal connections between pulmonary arteries and veins that bypass the pulmonary capillaries and transport deoxygenated blood through pulmonary veins to the left heart. This causes insufficient oxygenation of blood in the lungs. This condition remains symptomless for a long period of time. The most common symptoms include shortness of breath on exertion, nosebleeds, increased fatigue and a gradual development of cyanosis. Paradoxical embolism in the brain is a serious complication; it can present with a stroke or a brain abscess. Treatment of the disease consists of embolization of the pathological vascular connections, surgical resection of the affected pulmonary parenchyma and management of concomitant manifestations of the disease. PAVM in most common cases arises as a result of an autosomal dominant hereditary disorder referred to as hereditary hemorrhagic telangiectasia. Case report: In our communication, we document the diagnostic and therapeutic management in a young patient diagnosed with PAVM after falling off his bicycle. Based on comprehensive assessments, AV malformations with a 40% shunt of the pulmonary circulation were detected. An angiographic procedure was not an appropriate option considering the type and extent of the condition. Therefore, video-assisted thoracic resection of the affected pulmonary lobe was indicated. Conclusion: PAVM is a rare finding. PAVM should be ruled out in all patients with hereditary hemorrhagic telangiectasia (HHT) signs in the oral cavity. Contrast sonography of the heart and contract CT of the chest are the methods of choice for the diagnosis. Conservative or pharmacological treat-ment fails to improve the patients status. The condition is usually managed by embolization. Cases where PAVM is rather extensive or diffuse, where endovascular management would be inappropriate, can be well managed using endoscopic resection adequate to the extent of the condition.
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120
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121
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Affiliation(s)
- Emily C Bendel
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN.
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122
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Kirkpatrick DL, Frenette A, Hasham HA, Custer B, Lemons S, Collins Z, Alli A. Successful Percutaneous Treatment of an Arteriovenous Malformation of the Toe. Ann Vasc Surg 2019; 65:288.e5-288.e8. [PMID: 31778762 DOI: 10.1016/j.avsg.2019.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/25/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022]
Abstract
Arteriovenous malformations (AVMs) of the toe are a rare entity. To the author's knowledge, there are only 2 published case reports, and both patients underwent amputation of the affected digits. Little is known about the optimal treatment of AVMs involving the toe. The authors present the case of a 20-year-old male with a large AVM of the second toe, which was successfully treated with intra-arterial sodium tetradecyl sulfate. Percutaneous treatment of these lesions is possible and should be considered before amputation.
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Affiliation(s)
| | - Aaron Frenette
- The University of Kansas Medical Center, Kansas City, KS
| | | | - Brandon Custer
- The University of Kansas Medical Center, Kansas City, KS
| | - Steven Lemons
- The University of Kansas Medical Center, Kansas City, KS
| | | | - Adam Alli
- The University of Kansas Medical Center, Kansas City, KS
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123
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Gabeff R, Boccara O, Soupre V, Lorette G, Bodemer C, Herbreteau D, Tavernier E, Maruani A. Efficacy and Tolerance of Sirolimus (Rapamycin) for Extracranial Arteriovenous Malformations in Children and Adults. Acta Derm Venereol 2019; 99:1105-1109. [PMID: 31386166 DOI: 10.2340/00015555-3273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Managing extracranial arteriovenous malformations is challenging. Sirolimus (rapamycin) is increasingly being used when surgery and embolization are not advised. Because of its anti-angiogenic properties here we report all extracranial arteriovenous malformation cases treated with sirolimus in 2 French tertiary centers for vascular anomalies. The outcomes were efficacy (complete, partial, no response) based on arteriovenous malformation volume and necrosis/hemorrhage and side effects. We retrospectively included 10 patients (7 children). The sirolimus dose ranged from 0.6 to 3.5 mg/m2. Median (interquartile range [IQR]) treatment time was 24.5 (4.5; 35) months. Five patients showed no response and 5 showed partial response at a median (IQR) of 3 (1; 5) months followed in 2 cases by therapeutic resistance (i.e., progressive disease after 9 and 24 months of treatment). The most frequent side effect was mouth ulcers. This study shows poor efficacy of sirolimus for treating extracranial arteriovenous malformations.
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Affiliation(s)
- Romain Gabeff
- University of Tours, CHRU Tours, FR-37044 Tours, France
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124
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Kannath SK, Mandapalu S, Thomas B, Enakshy Rajan J, Kesavadas C. Comparative Analysis of Volumetric High-Resolution Heavily T2-Weighted MRI and Time-Resolved Contrast-Enhanced MRA in the Evaluation of Spinal Vascular Malformations. AJNR Am J Neuroradiol 2019; 40:1601-1606. [PMID: 31439626 DOI: 10.3174/ajnr.a6164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/01/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Volumetric high-resolution heavily T2-weighted imaging or time-resolved contrast-enhanced MRA is used in the detection and characterization of spinal vascular malformations, though inherent trade-offs can affect their overall sensitivity and accuracy. We compared the efficacy of volumetric high-resolution heavily T2-weighted and time-resolved contrast-enhanced images in spinal vascular malformation diagnosis and feeder characterization and assessed whether a combined evaluation improved the overall accuracy of diagnosis. MATERIALS AND METHODS Twenty-eight patients with spinal vascular malformations (spinal dural arteriovenous fistula, spinal cord arteriovenous malformation, and perimedullary arteriovenous fistula) were prospectively enrolled. MR images were separately analyzed by 2 neuroradiologists blinded to the final diagnosis. RESULTS Both sequences demonstrated 100% sensitivity and 93.5% accuracy for the detection of spinal vascular malformations. Volumetric high-resolution heavily T2-weighted imaging was superior to time-resolved contrast-enhanced MR imaging for identification of spinal cord arteriovenous malformations (100% versus 90% sensitivity and 96.7% versus 93.5% accuracy), however, for the diagnosis of perimedullary arteriovenous fistula, time resolved contrast enhanced MRI was found to perform better than the volumetric T2 sequence (80% versus 60% sensitivity and 96.7% versus 93.5% accuracy). Both sequences showed equal sensitivity (100%) and accuracy (87%) for spinal dural arteriovenous fistulas. Combined evaluation improved the overall accuracy across all types of spinal vascular malformation. Volumetric high-resolution heavily T2-weighted imaging was superior or equal to time-resolved contrast-enhanced MR imaging for feeder identification of spinal dural arteriovenous fistulas for both observers (90.9% and 72.7% versus 72.7%), which improved to 90.9% when the sequences were combined. Time-resolved contrast-enhanced MR imaging performed better for major and total feeder identification of spinal cord arteriovenous malformation (80% versus 60%) and perimedullary arteriovenous fistula (80% versus 60%-80%). CONCLUSIONS Combined volumetric high-resolution heavily T2-weighted imaging and time-resolved contrast-enhanced MR imaging can improve the sensitivity and accuracy of spinal vascular malformation diagnosis, classification, and feeder characterization.
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Affiliation(s)
- S K Kannath
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S Mandapalu
- Department of Radiology (S.M.), NRI Medical College, Chinakakani, Guntur, Andra Pradesh, India
| | - B Thomas
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - J Enakshy Rajan
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Kesavadas
- From the Department of Imaging Sciences and Interventional Radiology (S.K.K., B.T., J.E.R., C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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125
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Vimercati A, Crupano FM, Del Vecchio V, Cicinelli E. A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach. J Ultrasound Med 2019; 38:1921-1924. [PMID: 30480326 DOI: 10.1002/jum.14876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Antonella Vimercati
- Second Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Maria Crupano
- Second Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science, University of Bari Aldo Moro, Bari, Italy
| | - Vittoria Del Vecchio
- Second Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science, University of Bari Aldo Moro, Bari, Italy
| | - Ettore Cicinelli
- Second Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science, University of Bari Aldo Moro, Bari, Italy
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126
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Vaz-Pereira S, Collaço L. Evaluación multimodal de la malformación arteriovenosa de la retina en el síndrome de Wyburn-Mason. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:e21-e22. [PMID: 30514639 DOI: 10.1016/j.oftal.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 06/09/2023]
Affiliation(s)
- S Vaz-Pereira
- Department of Ophthalmology, Clínica São João de Deus, Lisbon, Portugal; Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal; Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - L Collaço
- Department of Ophthalmology, Clínica São João de Deus, Lisbon, Portugal
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127
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Narasimman S, Govindasamy H, Seevalingam KK, Paramasvaran G, Ramasamy U. Spontaneous massive haemothorax in the peri-partum period of an undiagnosed neurofibromatosis type 1 patient - A surgical perspective. Med J Malaysia 2019; 74:99-101. [PMID: 30846675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Acute massive haemothorax is a life-threatening situation, which is often associated with a preceding trauma. However, spontaneous haemothorax is a rare occurrence, especially in pregnancy. Spontaneous haemothorax in the immediate post-partum period secondary to a ruptured intercostal AVM is extremely rare more so in the background of an undiagnosed neurofibromatosis. This is a report of a young lady presenting with pleuritis and breathlessness after the delivery of her 1st child. Her management is discussed.
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Affiliation(s)
- S Narasimman
- Hospital Sultan Abdul Halim, Department of Surgery, Thoracic Surgery Unit, Sg Petani, Kedah, Malaysia.
| | - H Govindasamy
- Hospital Sultan Abdul Halim, Department of Surgery, Thoracic Surgery Unit, Sg Petani, Kedah, Malaysia
| | | | - G Paramasvaran
- Hospital Taiping, Department of Surgery, Perak, Malaysia
| | - U Ramasamy
- Hospital Taiping, Department of Surgery, Perak, Malaysia
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128
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Barandun S, Wyss A, Stucki A. [An Unusual Hemisphere Syndrome]. Praxis (Bern 1994) 2019; 108:59-62. [PMID: 30621534 DOI: 10.1024/1661-8157/a003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An Unusual Hemisphere Syndrome Abstract. A patient with known hereditary hemorrhagic telangiectasia presents with transient right arm weakness and dizziness. A transient ischemic attack is diagnosed on clinical and risk factors. In the course of the disease, the patient suffers a convulsive event and fever occurs twice without a clear focus on the infection. The initial skull MRI shows a centroparietal lesion on the left with signs of accompanying edema. Due to this unusual concomitant edema, a neoplastic event must also be considered for differential diagnosis. However, the further examinations show no evidence of neoplasia, but the course MRI of the skull shows the image of septic embolisms with a brain abscess. After neurosurgical remediation and appropriate antibiotic treatment, the clinical course is pleasing. The cause of the septic embolisms was a pulmonary arteriovenous malformation due to hereditary hemorrhagic telangiectasia, which could be coiled without complications.
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Affiliation(s)
| | - André Wyss
- 1 Spital Simmental-Thun-Saanenland AG, Thun
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129
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Boccalatte LA, Esteves da Cunha M, Miquelini LA. [Arteriovenous malformation in masseter]. Medicina (B Aires) 2019; 79:157. [PMID: 31048284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Luis A Boccalatte
- Sección Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Argentina. E-mail:
| | | | - Luis A Miquelini
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Argentina
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130
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Manzocchi Besson S, Robert-Ebadi H, La Scala G, Calza AM, Yilmaz H, Modarressi Ghavami SA, Bounameaux H, Righini M. [Arteriovenous malformations and its complex management]. Rev Med Suisse 2018; 14:2214-2219. [PMID: 30516890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Congenital arteriovenous malformations (AVM) represent a rare clinical entity. They are present at birth but can remain silent for many years. Due to their potential severity and their complex and specific management, the general practitioner should know when to suspect the presence of an AVM. Anatomic and hemodynamic characteristics of these malformations are well analysed by Doppler ultrasound, which is the first-line diagnostic test. MRI is often used in conjunction with ultrasound to better define the location and extension to neighbouring tissues and organs. Embolisation should be restricted to AVM associated with major functional disability, local complications or systemic cardiac complications in case of high flow volume life-threatening lesions.
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Affiliation(s)
| | | | | | | | - Hasan Yilmaz
- Service de neuroradiologie diagnostique et interventionnelle, HUG, 1211 Genève 14
| | | | | | - Marc Righini
- Service d'angiologie et d'hémostase, HUG, 1211 Genève 14
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131
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Affiliation(s)
- Yaron D Barac
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
| | - Carmelo A Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC
| | - Joseph W Turek
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC
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132
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Otani Y, Okabayashi T, Shibuya Y, Sumiyoshi T, Sui K, Iwata J, Morita S, Shimada Y. A Surgical Case of Inferior Mesenteric Arteriovenous Malformation. Surg Technol Int 2018; 33:101-104. [PMID: 30276782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The treatment option for inferior mesenteric arteriovenous malformations is under debate because of the number of cases. We, herein, report about a 35-year-old man with congenital inferior mesenteric artery malformation (AVM) presenting with mucous stool and severe abdominal pain. The radical operation, after building the diverting stoma, minimized the extent of the resection. This is the first reported case where surgical management was used to control severe symptoms induced by inferior mesenteric AVM.
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Affiliation(s)
- Yusuke Otani
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yuichi Shibuya
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Tatsuaki Sumiyoshi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan
| | - Sojiro Morita
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Yasuhiro Shimada
- Department of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
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133
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Abstract
Pulmonary arteriovenous malformation, a condition most commonly associated with hereditary hemorrhagic telangiectasia, is an abnormal communication between the pulmonary artery and pulmonary vein without an intervening capillary communication. Although asymptomatic in ~ 50% individuals, it can present with the dreaded complications of stroke or intracranial abscess in high-risk individuals including pregnant women, if untreated. The mainstay of treatment is now endovascular embolization of the feeding artery which can alleviate the symptoms and prevent these complications. In this review, we describe the pathophysiology, methods of screening, diagnostic workup and treatment of these vascular lesions with a particular focus on the currently used embolization techniques and their outcomes.
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Affiliation(s)
- Sreeshma Tellapuri
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Harold S Park
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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134
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Ghizzoni V, Gabbrielli S, Mannini L, Sorbi F, Turrini I, Fantappiè G, Pavone D, Fambrini M, Noci I. Spontaneous Resolution of an Acquired Uterine Arteriovenous Malformation in an Elderly Primigravida. Am J Case Rep 2018; 19:1140-1145. [PMID: 30258044 PMCID: PMC6180955 DOI: 10.12659/ajcr.909635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Uterine arteriovenous malformation (AVM) is an uncommon lesion characterized by an abnormal connection between arterial and venous circulation that can be congenital or acquired. Acquired uterine AVMs are generally traumatic and follow delivery, abortion, curettage, or uterine surgery. CASE REPORT A 45-year-old female who was gravida 1 para 0 presented to our hospital with severe vaginal bleeding. Two weeks before, the patient underwent therapeutic abortion. At admission, a transvaginal ultrasound showed an unclear intrauterine lesion that spread out to the myometrium. Color Doppler evaluation demonstrated an elevated color score. Beta human chorionic gonadotropin (beta-hCG) levels were measured at admission and daily repeated, with a progressive decrease of values up to a negative level. A pelvic magnetic resonance imaging described an area of tubular and tortuous structures involving the myometrium. A computed tomography angiography confirmed the presence of a lesion infiltrating the endometrium and myometrium containing arteriovenous structures with a highly enhanced effect. Despite these findings, the patient was clinically stable. A diagnosis of uterine AVM was made and, after accurate counselling with the patient, she was discharged and underwent "watch and wait" management. After 35 days, the patient had a follow-up ultrasound that showed a complete resolution of the uterine lesion. CONCLUSIONS AVM should be considered in the presence of heavy and sudden vaginal bleeding in a patient with risk factors for acquired AVM. A color Doppler ultrasound scan should be performed as the first approach and an expectant management should be taken into account especially with a patient of childbearing age and hemodynamic instability.
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Affiliation(s)
- Viola Ghizzoni
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | | | - Luca Mannini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Flavia Sorbi
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Irene Turrini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Giulia Fantappiè
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Dora Pavone
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Ivo Noci
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
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Abstract
Despite the continuing emphasis on the importance of clinical skills, these skills do not appear to be improving and may actually be declining. The 'unity of knowledge and action' is a medicine directed precisely at this disease. The 'unity of knowledge and action' helps to learn from failure and successes, learn from mistakes of predecessors and institute a behaviour that prevents repetition of these mistakes.
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Affiliation(s)
| | - Zhongxue Wu
- Zhongxue Wu, Beijing Neurosurgerical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, Tiantan Xili, No. 6, Beijing 100050, China.
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136
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Sherman A, Kim S, Craft W, Lewis D. Micro-arteriovenous malformation causing spontaneous metacarpal pad hemorrhage in a dog. Can Vet J 2018; 59:659-662. [PMID: 29910482 PMCID: PMC5949943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 5-year-old neutered male Labrador retriever dog with a 3-year history of intermittent hemorrhage from the right metacarpal pad was evaluated. A small region of hyperattenuation of the metacarpal pad was evident on computed tomographic angiography. Excisional biopsy of the location of the purported hemorrhage revealed a micro-arteriovenous malformation on histologic examination.
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Affiliation(s)
- Alec Sherman
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - Stanley Kim
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - William Craft
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - Daniel Lewis
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
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137
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Chatterjee A, Jackson AE, Acharya D, Law MA. Transcatheter Closure of Pulmonary Arteriovenous Malformation to Facilitate Treatment of Pulmonary Arterial Hypertension. JACC Cardiovasc Interv 2018; 11:e45-e46. [PMID: 29501545 DOI: 10.1016/j.jcin.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Arka Chatterjee
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ashley E Jackson
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deepak Acharya
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark A Law
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
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138
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Lacalm A, Fichez A, Broussin B, Abel C, Lacombe D, Guibaud L. Prenatal diagnosis of cerebral and extracerebral high-flow lesions revealing familial capillary malformation-arteriovenous malformation (CM-AVM) syndrome. Ultrasound Obstet Gynecol 2018; 51:409-411. [PMID: 28295764 DOI: 10.1002/uog.17460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Affiliation(s)
- A Lacalm
- Imagerie pédiatrique et fœtale, Centre Pluridisciplinaire de Diagnostic Prénatal, Consultation Multidisciplinaire des Angiomes, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
| | - A Fichez
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital de la Croix Rousse, Lyon, France
| | - B Broussin
- Centre d'imagerie, rue Georges Bonnac, Bordeaux, France
| | - C Abel
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital de la Croix Rousse, Lyon, France
| | - D Lacombe
- Génétique médicale, Centre Hospitalier Universitaire de Bordeaux, INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - L Guibaud
- Imagerie pédiatrique et fœtale, Centre Pluridisciplinaire de Diagnostic Prénatal, Consultation Multidisciplinaire des Angiomes, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
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139
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Varyanit N, Mathew C, Mammen KJ, Calton R. Massive Hematuria Due to Congenital Renal Arteriovenous Malformation Successfully Treated by Renal Artery Embolization. J Assoc Physicians India 2018; 66:83-85. [PMID: 30341878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Congenital renal arteriovenous malformations (AVMs) are rare benign vascular lesions and a rare cause of massive hematuria in females predominantly involving right kidney. Clinical presentation in a male with involvement of the left kidney is very rare. Only a few case series describing the outcome of congenital renal AVMs have been reported in the literature. We report a challenging case of a male patient with life threatening massive hematuria with congenital renal AVMs in left kidney. Successful embolization was performed using coils and gel foam.
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Affiliation(s)
| | | | | | - Rajneesh Calton
- Professor and Head, Department of Cardiology, Christian Medical College and Hospital, Ludhiana, Punjab
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140
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Asano Y, Tada A, Shinya T, Masaoka Y, Iguchi T, Sato S, Kanazawa S. Utility of second-generation single-energy metal artifact reduction in helical lung computed tomography for patients with pulmonary arteriovenous malformation after coil embolization. Jpn J Radiol 2018; 36:285-294. [PMID: 29429141 DOI: 10.1007/s11604-018-0723-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/03/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The quality of images acquired using single-energy metal artifact reduction (SEMAR) on helical lung computed tomography (CT) in patients with pulmonary arteriovenous malformation (PAVM) after coil embolization was retrospectively evaluated. MATERIALS AND METHODS CT images were reconstructed with and without SEMAR. Twenty-seven lesions [20 patients (2 males, 18 females), mean age 61.2 ± 11.0 years; number of embolization coils, 9.8 ± 5.0] on contrast-enhanced CT and 18 lesions of non-enhanced lung CT concurrently performed were evaluated. Regions of interest were positioned around the coils and mean standard deviation value was compared as noise index. Two radiologists visually evaluated metallic coil artifacts using a four-point scale: 4 = minimal; 3 = mild; 2 = strong; 1 = extensive. RESULTS Noise index was significantly improved with SEMAR versus without SEMAR (median [interquartile range]; 194.4 [161.6-211.9] Hounsfield units [HU] vs. 243.9 [220.4-286.0] HU; p < 0.001). Visual score was significantly improved with SEMAR versus without SEMAR (Reader 1, 3 [3] vs.1 [1]; Reader 2, 3 [3] vs.1 [1]; p < 0.001). Significant differences were similarly demonstrated on lung CT (p < 0.001). CONCLUSION SEMAR provided clear chest CT images in patients who underwent PAVM coil embolization.
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Affiliation(s)
- Yudai Asano
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan.
| | - Akihiro Tada
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan
| | - Takayoshi Shinya
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan
| | - Shuhei Sato
- Department of Health Informatics, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, 700-8558, Okayama, Japan
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141
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Kitagawa A, Yamamoto T, Matsunaga N, Yamaji M, Ikeda S, Izumi Y, Hagihara M, Ota T, Ishiguchi T. Polidocanol Sclerotherapy Combined with Transarterial Embolization Using n-Butyl Cyanoacrylate for Extracranial Arteriovenous Malformations. Cardiovasc Intervent Radiol 2018; 41:856-866. [PMID: 29417264 PMCID: PMC5937878 DOI: 10.1007/s00270-017-1855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Purpose To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). Materials and Methods Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4–74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture. Results Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76–99% in 13, 50–75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications. Conclusion Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Affiliation(s)
- Akira Kitagawa
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mayako Yamaji
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
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142
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Bandura P, Rawnaq T, Holzknecht A, Cetin E, Reemts P, Zoi P, Schwärzler P. Management of Intrauterine Arteriovenous Malformation (AVM) in 14 Patients by Sonographically Guided Tisseel Application. Ultraschall Med 2018; 39:48-55. [PMID: 26565517 DOI: 10.1055/s-0041-107764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss. MATERIALS AND METHODS A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEEL®), thus allowing for super-selective occlusion of the feeding vessels. RESULTS The procedure was technically successful in all 14 patients, 3 of whom (21 %) had a repeated procedure after 4 - 7 days. The mean age (yrs.) of the patients was 31 (25 - 40), the gravity was median 2 (1 - 5) and the parity was median 1 (0 - 4), the lowest Hb value was on average 9.35 ± 2.25 (5.2 - 14.2) g/dl, the lowest Ht was on average 30.82 ± 6.02 (18 - 41 %). Spectral Doppler analysis revealed an average of 80.71 ± 11.2 (66 - 115) cm/sec for the maximal detectable PSV. In the period of 4 - 55 months after treatment, 7 patients (50 %) had 8 successful pregnancies and 2 miscarriages. CONCLUSION In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.
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Affiliation(s)
- Patrick Bandura
- Obstetrics & Gynecology, Semmelweis University Budapest, Asklepios Campus Hamburg, Germany
| | - Tamina Rawnaq
- Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
| | | | - Emine Cetin
- Obstetrics & Gynecology, Center for Prenatal Diagnosis and Fetal Genetics, Hamburg, Germany
| | - Petra Reemts
- Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
| | - Panagiota Zoi
- Obstetrics & Gynecology, Asklepios Pro-research, Hamburg, Germany
| | - Peter Schwärzler
- Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany
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143
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Chen D, Dong M, Zhao K, Sun F, Wang H, Liu Z. Unusual synchronous liver and brain abscesses infected by rare Aerococcus viridians in a patient with pulmonary arteriovenous malformations on FDG PET/CT: A case report and literature review. Medicine (Baltimore) 2017; 96:e9048. [PMID: 29245306 PMCID: PMC5728921 DOI: 10.1097/md.0000000000009048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pulmonary arteriovenous malformations (PAVMs) complicated with multiple organ abscesses is an uncommon manifestation. Because of the low incidence of the disease, F-18 fluorodeoxyglucose positron emission tomography with computed tomography (F-FDG PET/CT) imaging studies for PAVMs complicated with multiple organ abscesses are scarce. PATIENT CONCERNS We report a case of a 54-year-old man presenting with PAVMs complicated with synchronous multiple organ abscesses founded by F-FDG PET/CT. F-FDG PET/CT revealed tortuous stripes and mass opacities with no significant FDG uptake in the left upper lung lobe. However, hypermetabolic lesions located in the anterior inferior segment of right hepatic lobe [with maximum standardized uptake value (SUVmax) of 10.7], and in the right basal ganglia with SUVmax of 14.1 were found by F-FDG PET/CT. DIAGNOSES A diagnosis of synchronous liver and brain abscesses infected by rare Aerococcus viridans was determined by tissue culture. INTERVENTIONS Vancomycin was provided intravenously, and oral linezolidate tablets were prescribed for anti-inflammatory treatment for 1 month. Liver and head magnetic resonance imaging was performed during the follow-up. OUTCOMES The lesion in the right basal ganglia was reduced, and the lesion in the right liver had disappeared, indicating the lesions were abscesses. LESSONS The present case indicated that the possibility of abscesses should be considered with patients with PAVMs, and whole-body F-FDG PET/CT is suggested to identify possible accompanying abscesses in multiple organs for PAVMs patients.
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Affiliation(s)
- Donghe Chen
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
| | - Mengjie Dong
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Kui Zhao
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Fang Sun
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
| | - Huatao Wang
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
| | - Zhengfeng Liu
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang
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144
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Iraha Y, Okada M, Toguchi M, Azama K, Mekaru K, Kinjo T, Kudaka W, Aoki Y, Aoyama H, Matsuzaki A, Murayama S. Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions. Jpn J Radiol 2017; 36:12-22. [PMID: 29052024 DOI: 10.1007/s11604-017-0687-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/27/2017] [Indexed: 12/18/2022]
Abstract
Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported. Gestational trophoblastic disease is rare but commonly presents as secondary PPH and resembles RPOC in radiologic appearance. The first-line imaging modality for secondary PPH is ultrasound, but computed tomography and magnetic resonance imaging may be used if the ultrasound findings are indeterminate. Angiography is an important tool for the definitive diagnosis of uterine vascular abnormalities. Appropriate management requires radiologists to be familiar with the multimodality imaging features of secondary PPH or postabortion hemorrhage.
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Affiliation(s)
- Yuko Iraha
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Masahiro Okada
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Masafumi Toguchi
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Kimei Azama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Keiko Mekaru
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Tadatsugu Kinjo
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hajime Aoyama
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Akiko Matsuzaki
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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Tenkumo C, Kanenishi K, AboEllail MAM, Yamamoto K, Ishibashi M, Mori N, Tanaka H, Hata T. HDlive Flow silhouette mode for the diagnosis of uterine enhanced myometrial vascularity/arteriovenous malformations. J Med Ultrason (2001) 2017; 45:349-352. [PMID: 28840423 DOI: 10.1007/s10396-017-0823-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Abstract
We present our initial experience of using the HDlive Flow silhouette mode to construct images of two cases of uterine enhanced myometrial vascularity/arteriovenous malformations (EMV/AVMs). In the first case, the HDlive Flow silhouette mode clearly depicted a fused vascular tumor with irregular contour in the posterior myometrium. In the second case, a large hypervascular mass occupying the entire fundal lesion of the uterus was clearly identified using the HDlive Flow silhouette mode. Moreover, spatial relationships among the hypervascular mass, intrauterine blood collection, and dilated, spiral-shaped right uterine artery enabled the clear localization of the mass. The HDlive Flow silhouette mode provides a novel, unique sonographic image of uterine EMV/AVMs, and might facilitate their diagnosis and localization in the myometrium.
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Affiliation(s)
- Chiaki Tenkumo
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Mohamed Ahmed Mostafa AboEllail
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenta Yamamoto
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Megumi Ishibashi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Hirokazu Tanaka
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
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147
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Abstract
CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.
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Affiliation(s)
- Massoud Baghai Wadji
- MD. Associate Professor of Surgery, Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Athena Farahzadi
- MD. Resident of General Surgery, Iran University of Medical Sciences, Rasool Akram Hospital, Shahrara, Tehran, Iran
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148
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Affiliation(s)
- Jack Diep
- Department of Anesthesiology & Perioperative Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Kartik Dandu
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ming Xiong
- Department of Anesthesiology & Perioperative Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Steven M Shulman
- Department of Anesthesiology & Perioperative Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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149
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Abstract
Arteriovenous haemangiomas within the chest are rare and uncommonly documented. After a 60-year-old woman with a history of smoking underwent a routine chest X-ray revealing a right apical mass, further investigations led to the discovery of a large extrapulmonary arteriovenous haemangioma in the superior mediastinum. Additionally, this case became complicated when the hemangioma was found to not only be compressing adjacent major arteries and veins, but also invading into the spinal canal and displacing the spinal cord. With multidisciplinary planning, the arteriovenous haemangioma was embolised and successfully resected. Thus, we present a case of an arteriovenous haemangioma in the superior mediastinum and discuss the importance of the case.
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Affiliation(s)
- Alberto Anthony Goizueta
- Internal Medicine, Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA
| | - Peter Libbey
- Department of Pathology, Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA
| | - Anthony Moulton
- Department of Vascular/Cardiothoracic Surgery, Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA
| | - Rabih El-Bizri
- Pulmonary/Critical Care, Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA
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150
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Mirchevski V, Zogovska E, Chaparoski A, Filipce V, Kostov M, Mirchevski MM. Circonscript Subcutaneous Arteriovenous Malformation of the Head. ACTA ACUST UNITED AC 2017; 38:41-45. [PMID: 28593889 DOI: 10.1515/prilozi-2017-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study is to show the various possibilities to treat this rare malformation, accentuating the results of the early surgical treatment before complications. MATERIAL The authors present 8 cases of patients with subcutaneous arteriovenous malformations, 5 females and 3 males (age of 7, 13, 19, 23, 27, 52 and 58 years) treated in the period of 1999 until 2015 at the Clinic for Neurosurgery and the Clinic for Plastic, Aesthetic and Reconstructive Surgery in Skopje, Republic of Macedonia. This malformation has been observed by the parents in the childhood, around the age of 3 years in all cases. Local red circonscripted nodule, soft, with manually discharging tendency and varicose dilated veins have been observed in all cases, deaf on both sides in one case, while in the older case, a cavernous sinus thrombosis caused unilateral exophthalmia, hyaline indurated ophthalmic vein, vertigo, arrhythmia, heart failure and bradypsychia have been observed. The size of the malformation has been from 2.5 to 7 cm. The diagnostics was done using CT, CT-angiography and digital angiography including external carotid angiography. Endocranial arterials peduncle was present in all cases. RESULTS Six cases underwent surgery, while two cases were treated with several treatments of endovascular embolization. The follow up has been ranged from 2 to 15 years. All surgically treated patients improved without recurrence, the exophthalmia, bradypsychia and the heart problems regressed, while in patients treated with endovascular non-complete occlusion the AVM decreased, but still remained. IN CONCLUSION The Surgical treatment remains a first option if it is possible, and as earlier as possible, while embolization is a useful tool in cases where a complete excision is not possible.
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Affiliation(s)
| | - Elizabeta Zogovska
- University Clinic for Plastic, Aesthetic and Reconstructive Surgery, Clinical Center "Mother Teresa" Skopje
| | | | - Venko Filipce
- University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje
| | - Milenko Kostov
- University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje
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