Atrial fibrillation and right bundle branch block complicating coil embolization of a huge pulmonary arterio-venous malformation

Coil embolization is a safe therapy for pulmonary arterio-venous malformations (PAVMs). We report the case of a 72-year-old woman affected by hereditary hemorrhagic teleangectasia who experienced right bundle branch block and atrial fibrillation 36 hours after embolization of an extended PAVM. To our knowledge, this is the first case of such a complication of embolization of a pulmonary fistula, presumably due to an acute pressure overload on both the right atrium and ventricle. This case report suggests that, after embolization of extended pulmonary fistulas, patients should be carefully monitored for rhythm disturbance and new onset of intraventricular conduction defects.

Large pulmonary arteriovenous malformation diagnosed by cardiovascular magnetic resonance

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High-flow arteriovenous malformations of the mandible and the maxilla: report of 2 cases

Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.

Haemorrhage from a radiosurgically treated arteriovenous malformation after its angiographically proven obliteration: a case report

Small lower-grade Spetzler-Martin arteriovenous malformations (AVMs) are mainly treated by microsurgical resection or stereotactic radiosurgery. The choice of treatment largely depends on the referring centre's preference and the patient's decision. We present here a patient with an AVM repeatedly treated at our Leksell Gamma Knife unit with radiographically confirmed obliteration of the AVM which subsequently began bleeding. This case demonstrates the possibility of late complications in radiosurgically treated AVMs even after their demonstrable obliteration. Meticulous histological examination was performed, proving patency of the AVM nidus. The risk of haemorrhagic complications of radiosurgically removed AVMs despite angiographic proof of their obliteration is, in our view, a cogent argument for preferring surgical resection if the AVM is accessible and for prolonged follow-up after radiosurgical treatment of an AVM.

Face skin necrosis following embolization for arteriovenous malformations: a case report

INTRODUCTION

Arteriovenous malformations (AVMs) are rare in the oral and maxillofacial regions.

DISCUSSION

AVMs may induce severe complications such as uncontrollable bleeding. Superselective intra-arterial embolization is an effective method for this bleeding that is refractory to conservative treatment. Arterial embolization may cause ischemic complications. We report the case of a patient who developed face skin necrosis following bilateral facial artery embolization.

Endovascular embolization of pulmonary arteriovenous malformations

BACKGROUND

The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc.

METHODS

Patients (n = 23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.

RESULTS

Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04 + or - 8.22)% to (95.13 + or - 3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (t = 9.101, P < 0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood oxygen saturation between 85% and 90%. Symptoms of hypoxia never recurred in the other cases.

CONCLUSIONS

Endovascular embolization of pulmonary arteriovenous malformations can significantly improve blood oxygen saturation and reduce serious complications such as cerebral infaction. Therefore, this kind of interventional procedure is a safe and effective treatment method with a low complication rate.

Sonographic identification of lower limb venous hypoplasia in the prenatal diagnosis of Klippel-Trénaunay syndrome

We report the prenatal identification of lower-limb venous hypoplasia to support a provisional prenatal diagnosis of Klippel-Trénaunay syndrome (KTS). Ultrasound assessment of a fetus with marked lower-limb edema, cystic areas in the abdomen/pelvis/lower limbs and abnormal development of the feet demonstrated bilateral hypoplasia of the femoral and popliteal veins. The external iliac veins and the great saphenous veins were seen to be normal. The lower limb arterial system was present. These findings supported KTS as the most likely provisional diagnosis, and postnatal clinical evaluation confirmed that the infant is best classified in the spectrum of KTS. Venous hypoplasia was confirmed with a postnatal ultrasound examination of the lower limbs. This case suggests that careful examination of the lower-limb venous system may be helpful in making the prenatal diagnosis of KTS.

Postrenal biopsy AVM leading to severe hypertension and dilated cardiomyopathy

A 3-year-old girl with Alport syndrome presented with decompensated heart failure from hypertension-induced cardiomyopathy 6 months following renal biopsy. Selective renal angiography revealed a large left renal arteriovenous fistula (AVF) with poor perfusion to the left renal parenchyma. The AVF was treated by transcatheter embolization using an Amplatzer vascular plug. Her blood pressure normalized after embolization, and her cardiac function normalized over the following 4 months.

"Right-sided" May-Thurner syndrome

The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a "right-sided" May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carried out, with good patency and clinical result at 12-month follow-up.

Ethanol embolization of arteriovenous malformations of the mandible

BACKGROUND AND PURPOSE

Absolute ethanol was reported as an effective embolization of arteriovenous malformations (AVMs), but its use to treat AVMs in the mandible is not yet well established. Here, we present our clinical experience on treatment of mandibular AVMs with absolute ethanol.

MATERIALS AND METHODS

Eight consecutive patients with symptomatic AVMs of the mandible between August 2007 and September 2008 were enrolled in this study group. Among them, 6 patients underwent direct puncture embolization with absolute ethanol combined with coils, 1 patient underwent direct puncture embolization with absolute ethanol only, and the last patient had transarterial embolization with absolute ethanol alone. The use of coils decreased the flow and volume of the nidus, and then absolute ethanol embolization was directed against and obliterated the nidus completely. The procedure was performed with the patients under general anesthesia with nasal intubation, and the vital signs of the patients were constantly monitored during the injection of absolute ethanol. The total amount of absolute ethanol used per session was less than 1 mL/kg of body weight.

RESULTS

A total of 11 ethanol embolizations were performed on 8 patients, including 3 sessions with transarterial microcatheterization and 8 with direct puncture embolization. A venogram and control arteriogram performed immediately after the procedure were both obtained, which documented a significant thrombosis of the lesion in all patients. Follow-up examinations revealed that oral bleeding was controlled, the expansion of the external jugular vein in 5 cases was obliterated, and satisfactory shrinkage of the facial swelling was achieved. Follow-up angiography (mean, 4.2 months) was available in 4 patients, and there was no angiographic recurrence of the lesions. There were 3 cases with minor complications.

CONCLUSIONS

On the basis of our experience, treatment of AVMs in the mandible with absolute ethanol is a feasible, safe, and highly effective method.

A new CT-based classification of spontaneous supratentorial intracerebral haematomas

BACKGROUND AND PURPOSE

In patients with intracerebral haematoma (ICH) secondary to ruptured aneurysm or arteriovenous malformation (AVM), conservative therapy and follow-up without angiographic evaluation is associated with a risk of recurrent bleeding. It is necessary for a clinician to identify a subgroup of patients with spontaneous supratentorial ICH who are likely to harbour high-flow vascular malformations that require specific treatment - neurosurgical or neuroradiological. A new CT-based classification for supratentorial ICH aimed at a close correlation between ICH localization and occurrence of high-flow vascular malformations diagnosed on angiography is presented.

MATERIAL AND METHODS

According to the proposed classification, supratentorial ICHs are divided into deep and cortico-subcortical. The deep group is further subdivided into striatocapsular, lobar ICH and isolated intraventricular haemorrhage and the cortico-subcortical group into paracisternal and convexity ICH. A new classification was used in a consecutive series of 108 patients with spontaneous supratentorial ICH subjected to angiographic evaluation.

RESULTS

Deep ICH in non-hypertensive patients was secondary to AVM rupture in 57.1% (8/14). High-flow vascular malformation was a source of bleeding in 93.6% of patients with paracisternal ICH - aneurysm in most cases (41/47). Convexity ICH was found to be AVM-related in 35.7% of patients (5/14).

CONCLUSIONS

Our clinical experience shows that the proposed classification appears to be closely associated with angiographic findings. Its clinical application with consideration of other factors such as age and arterial hypertension may help clinicians to identify high-risk ICH patients for angiographic evaluation and further specific treatment to prevent rebleeding.

The value of CT venography in the diagnosis of jugular bulb diverticulum: a series of 3 cases

Jugular bulb diverticulum is a rare diagnosis, as fewer than 50 cases have been reported in the literature. It has been reported that unilateral auditory symptoms may accompany this entity, although some patients are asymptomatic. We present a case series of 3 patients who were referred to our tertiary care neurotology center with a unilateral jugular bulb diverticulum along with unilateral sensorineural hearing loss and tinnitus. These patients were evaluated clinically and radiographically. This case series (1) adds further documentation of the presence of unilateral auditory symptoms in patients with a jugular bulb diverticulum and (2) demonstrates the value of computed tomographic venography in the diagnosis of jugular bulb diverticulum.

[Hyperintensity on T2 MRI and size as predictors of obliteration in radiosurgically treated arteriovenous malformations]

OBJECTIVE

The aim of this study was to determine which factors were statistically related to radiological and clinical outcomes following radiosurgical treatment of arteriovenous malformations (AVMs).

METHODS

The data of 59 patients receiving radiosurgical treatment at our department were retrospectivelly reviewed. Different clinical and biological data, including Spetzler-Martin grade, the presentation of symptoms, radiation dose, number of isocenters and both radiological and clinical outcome, were subjected to multivariate analysis.

RESULTS

AVM obliteration was achieved in 77% of patients, the majority of them occurring between 3-5 years after treatment. Ten patients (17%) showed either acute or delayed complications. Only one patient died due tor hemorrhage during the follow-up after radiosurgery. A multivariate analysis showed that, hyperintensity on T2 MRI and a nidus smaller than 3 cm were the only factors statistically related to oclusion of the AVM (p=0.03 and p=0.05, respectively).

CONCLUSION

The nidus size and the development of hyperintensity on T2 MRI after the treatment were the strongest predictive factors of obliteration in our series of AVMs radiosurgically treated. Moreover, given that many AVMs showed complete obliteration between 3-5 years after treatment, we recommend to wait untill 5 years after treatment before considering a new terapeuthic approach in patients showing small residual nidus at control imaging.

Pulmonary arteriovenous malformation: a rare cause of cyanosis in a child

Pulmonary arteriovenous malformations are rare vascular anomalies. We report a 12-year-old girl who presented with exertional dyspnoea, cyanosis and clubbing since the age of five years, and multiple pulmonary arteriovenous malformations. Computed tomography pulmonary angiogram showed a large pulmonary arteriovenous malformation at the lower lobe of the right lung. Pulmonary angiogram showed a large right lung arteriovenous malformation and two small left lung arteriovenous malformations. The multiple arteriovenous malformations were occluded with Gianturco coils. She is now asymptomatic and on regular follow-up.

Living donor liver transplantation as a means of rescuing post-embolization hepatic failure in a patient with idiopathic intrahepatic arteriovenous malformation in the liver

Interventional radiology used to be a first-line treatment for cardiac failure caused by idiopathic hepatic arteriovenous malformation (AVM). Here, we report a 64-year-old male patient treated by living donor liver transplantation (LDLT) following failed hepatic artery embolization for idiopathic hepatic AVM. Hepatic artery reconstruction in LDLT was very difficult in this case due to the adverse effects of the pre-transplant intervention. In the treatment of widespread AVM in the liver, arterial embolization should be avoided and primary liver transplantation should be considered.

Pancreatic arteriovenous malformation: a rare manifestation of hereditary hemorrhagic telangiectasia

We present Doppler ultrasound, computed tomography and angiography findings of a rare pancreatic arteriovenous malformation associated with hereditary hemorrhagic telangiectasia.

Pancreatic arteriovenous malformation: a case report of hemodynamic and three-dimensional morphological analysis using multi-detector row computed tomography and post-processing methods

CONTEXT

Although rare, a pancreatic arteriovenous malformation can have serious consequences. A diagnosis of arteriovenous malformation requires evidence of aberrant communication between the arterial and the venous systems. This report describes a case where the use of multi-detector row CT and specific post-processing methods provided a diagnosis of arteriovenous malformation. This minimally invasive diagnostic approach resulted in a clear, precise and comprehensive visual representation of the pancreatic arteriovenous malformation.

CASE REPORT

A 60-year-old man with right hypochondriac pain presented with a mass in the head of the pancreas. The hypochondriac pain resolved spontaneously and physical examination revealed no abnormal findings. A multi-detector row CT study was performed. The data obtained in the arterial phase demonstrated a high-contrast mass in the head of the pancreas and early enhancement of the portal vein. A maximum intensity projection method clarified the aberrant vascular communication. Changes in Hounsfield numbers were observed using a multi-planar reformation method. A volume-rendering method was used to create a 3D model which demonstrated the spatial relationship between the aberrant vascular communication and the surrounding tissue. An annual follow-up study using this technique showed no significant alteration.

CONCLUSIONS

Multi-detector row CT with specific post-processing methods is a useful diagnostic tool for pancreatic arteriovenous malformation.

[Treatment of arterio-venous high-flow vascular malformations of the mandible]

Arterio-venous vascular malformations (AVM) rarely occur in craniofacial bones. The most frequent location has been reported in the mandible. The first clinical evidence of the lesions can be a fatal hemorrhage, occurring spontaneously or subsequent to dental therapy. Lack of knowledge about these lesions among specialists dealing with the oral and maxillofacial regions can lead to fatal complications. The study presents the successful multidisciplinary management of two cases of mandibular AVM using embolization, sclerotherapy and bone reconstruction, a major challenge owing to the substantial risk of morbidity, recurrence by recanalization and revascularization, neurologic deficits and mortality. There were no complications over a follow-up period of 12 years.

Massive spontaneous hemothorax during the immediate postpartum period

Nontraumatic hemothorax is a rare cause of postpartum respiratory distress. We present a case of massive spontaneous hemothorax, which presented during the immediate postpartum period and was initially treated as pulmonary embolism. Further investigation revealed a tiny lung nodule: although pulmonary arteriovenous malformation was considered, the imaging appearances tended to counter this interpretation. Eventually, in the absence of another cause for spontaneous hemothorax, on either clinical or imaging grounds, we diagnosed spontaneous arteriovenous malformation. Its management is discussed herein.

Venous malformation of the neck with giant phleboliths

We present a case involving a 76-year-old man with a massive right-sided vascular neck mass that had been present since birth. The mass had been stable throughout the patient's life, but recently a portion of it had become hard. Physical examination revealed a firm, palpable focus within the vascular lesion in the right side of the neck. Computed tomography revealed the presence of numerous hyperdense foci, many more than 2 cm in size, which were confirmed by fine-needle aspiration to be phleboliths. The patient was followed for 6 months to ensure that the vascular mass and phleboliths remained stable.

Color Doppler sonography of intrahepatic vascular shunts

PURPOSE

To illustrate the sonographic and Doppler features of the different types of intrahepatic vascular shunts.

METHODS

Patients presenting in our department with intrahepatic vascular shunts with healthy livers or with a variety of liver pathologies underwent color Doppler interrogation and spectral analysis.

RESULTS

Intrahepatic vascular shunts may involve all liver vessels. Arterioportal and arteriosystemic venous connections can be recognized in normal and cirrhotic livers, following trauma, within tumors, and within nontumoral arteriovenous malformations. Portosystemic intrahepatic venous shunts are categorized into 4 morphologic types. Systemic-to-systemic shunts are more often recognized in patients with chronic hepatic venous congestion or with Budd-Chiari syndrome. Portal-to-portal intrahepatic venous shunts are rare, with few cases described.

CONCLUSION

In general, all the liver vessels can be associated with formation of arterioportal, arteriosystemic, and portosystemic venous shunts and, rarely, systemic venous shunts and portal-to-portal communications. Sonography allows characterization of the different intrahepatic shunts.

Sonography of uterine abnormalities in postpartum and postabortion patients: a potential pitfall of interpretation

OBJECTIVE

The interpretation of postpartum and postabortion uterine abnormalities on sonography can be challenging. The purpose of this study was to identify misleading imaging features that lead to inclusion of a uterine arteriovenous malformation (AVM) in the differential diagnosis of a uterine abnormality because consideration of this diagnosis can potentially alter patient treatment.

METHODS

The sonographic examinations of 29 pathologically proven cases of uterine abnormalities in postpartum and postabortion patients were retrospectively reviewed. Two radiologists independently evaluated several features: the presence of a uterine mass, myometrial involvement, and the presence of an associated vascular abnormality. Percent agreement and the relationship between imaging features and inclusion of a uterine AVM in the differential diagnosis were determined.

RESULTS

Interobserver agreement was as follows: the presence of a uterine mass, 90%; myometrial involvement, 83%; the presence of an associated vascular abnormality, 72%; and inclusion of a uterine AVM in the differential diagnosis, 86%. Myometrial involvement showed a statistically significant relationship to inclusion of a uterine AVM in the differential diagnosis (P < .05). Final pathologic diagnoses included retained products of conception (RPOC) (n = 26), an endometrial polyp (n = 1), chronic endometritis (n = 1), and an exogenous progestational effect (n = 1). No uterine AVMs were found.

CONCLUSIONS

Despite high interobserver agreement in characterizing uterine abnormalities on sonography, readers still include uterine AVMs in the differential diagnosis of uterine masses that are ultimately proven to be RPOC. A myometrial location of a uterine mass is a particularly misleading imaging feature of RPOC.

[Detection of cardial and extracardial right-to-left shunts in young stroke patients]

BACKGROUND

The aim of this study was to determine the frequency of extracardial and particularly pulmonal right-to-left-shunts (RLS) in patients with acute cerebral ischemia of unknown origin.

PATIENTS AND METHODS

We investigated 52 patients under 60 years of age with cerebral ischemic stroke of unknown origin using transesophageal echocardiography (TEE) with special attention to the late phase of ultrasound contrast medium in the left atrium. Additionally we performed contrast transcranial doppler sonography (TCD).

RESULTS

In the TEE, 25 patients (48%) showed cardial RLS. In seven patients with normal TEE (13.5%) we found evidence of RLS with contrast TCD (spontaneous RLS n=4, RLS after valsalva n=3). In none of these seven patients did we find late-phase contrast in the left atrium.

CONCLUSION

The constellation of RLS detection in contrast TCD but not in TEE was frequently found. Particularly in spontaneous RLS, this constellation raises the suspicion of a pulmonary shunt. However our extended TEE protocol did not give additional evidence for a pulmonary location of the shunt.

[The scintigraphic 99mTc-MAA imaging quantification of the right-to-left shunt in a patients with multiple pulmonary arteriovenous malformation and familial teleangiectasis]

AIM

To present a case report about 57-years-old woman with hypoxemia, multiple pulmonary arteriovenous (AV) malformations and lips teleangiectasis where the right-to-left shunt quantification was assessed by means of whole body scintigraphy with 9mTc-labelled human macro-aggregated albumin (MAA).

MATERIAL AND METHOD

A 57-years-old woman underwent X-ray and bolus enhanced lung CT for dyspnoea, hypoxemia and cyanosis. A multiple intrapulmonary arteriovenous malformations were detected. The whole-body 99mTc-MAA scintigraphy for the right-to-left shunt quantification was performed. The whole-body scintigraphy in anterior and posterior view was started after intravenous application of 185 MBq 99mTc-MAA. The double-head gamma camera Infinia (General Electric Medical Systems--GE MS) with infrared body countouring and the large field of view was used. The Gamma camera was fitted with low-energy, high resolution, parallel-hole collimator. Images were evaluated by processing system Xeleris (GE MS).

RESULTS

The whole-body 99mTc-MAA scintigraphy revealed significant R-L shunt and uptake of radiotracer in extrapulmonary organs (brain, kidney, spleen). The right-to-left shunt ratio was 36%. The woman underwent successful percutaneous transcatheter microembolization treatment. After treatment the woman underwent the next 99mTc-MAA whole-body scintigraphy and the R-L shunt ratio decreased to 17%.

CONCLUSION

The 99mTc-MAA whole-body scintigraphy assessed the right-to-left shunt ratio and improved the management of patients with multiple intrapulmonary A-V malformations. The next 99mTc-MAA scintigraphy after the percutaneous transcatheter microembolization of multiple intrapulmonary A-V malformations confirmed success of treatment.

Role of contrast-enhanced 3D magnetic resonance portography in evaluating portal venous system compared with color Doppler ultrasonography

AIM

The purpose of this study was to evaluate the capability of contrast-enhanced three-dimensional (3D) MR portography in detecting abnormal findings associated with the portal venous system compared with the results of color Doppler ultrasonography (CDUS).

MATERIALS AND METHODS

MR portography findings were retrospectively compared with the results of CDUS examinations in 161 patients, who were suspected of having portal venous system abnormalities. Portal venous vessels were divided into main 5 groups including the main portal vein, its left and right intrahepatic branches, splenic vein and superior mesenteric vein. Imaging findings were classified as normal, occluded, or partially thrombosed. Results of clinical and imaging follow-up examinations including CDUS, MR portography or angiography, if available, were used as a proof of final diagnosis. The potential sites of varicose veins and collateral vessels were also examined by both imaging methods.

RESULTS

Vascular abnormalities were identified in 79 of 161 patients. There was a statistically significant agreement between the results of MR portography and CDUS in evaluating portal venous system (kappa = 0.871, P < 0.05). The sensitivity of MR portography was slightly superior to CDUS in detecting partially thrombosis and occlusion in the main portal venous vessels. In addition, MR portograms were superior to CDUS in the management of patients with portal hypertension by identifying portosystemic collaterals more adequately, and clearly demonstrated portal venous vessels that cannot be visualized at CDUS.

CONCLUSION

Results of present study indicates that contrast-enhanced 3D MR portography is well suited and superior to CDUS in the management of patients with portal hypertension.

A congenital fistula between the descending aorta and the right pulmonary vein in a neonate presenting with heart failure

We report a large congenital fistula connecting the descending thoracic aorta to the right upper pulmonary vein in a newborn baby presenting on the seventh day of life with cardiac failure and a continuous murmur heard posteriorly. The fistula was detected echocardiographically, and shown at cardiac catheterisation not to be suitable for percutaneous occlusion. The anatomy of the fistula was confirmed at surgery, when it was ligated successfully.

Arteriovenous malformation of the mandible: a case report

Arteriovenous malformations (AVMs) are an abnormal collection of blood vessels. They are extremely rare congenital or acquired abnormalities in the structure of blood vessels. These malformations have been associated with severe hemorrhage resulting in significant morbidity and mortality. Gingival bleeding seems to be a common symptom of most documented cases of AVM, and radiographs most often appear normal. A 12-year-old girl who was first examined by a general dentist for occasional bleeding associated with the right mandibular teeth was referred to the University of Istanbul, Faculty of Dentistry. During the suturing process to stop the leakage around the mandibular right first molar, uncontrollable hemorrhage began. Magnetic resonance imaging and angiogram revealed the AVM of the right mandibular body. After embolization with an injection of a mixture of cyanoacrylate and lipiodol, the tooth was extracted and initial periodontal therapy performed. The patient has maintained a satisfactory gingival and oral condition since the completion of dental treatment and establishment of oral hygiene. Clinicians should be aware of these lesions and the impact they can have on routine procedures. Proper recognition and therapeutic intervention can help to avoid serious complications and potentially tragic outcomes.

Endovascular Treatment of Common Iliac Occlusion in the Presence of Persistent Sciatic Artery

Persistent sciatic artery is a rare congenital anomaly. It is associated with increased incidence of aneurysmal dilatation, thrombosis, distal embolization, and atherosclerotic change. We describe the case of a patient with persistent sciatic artery who presented with a critically ischemic left leg as a result of an occluded left common iliac artery, which was treated by angioplasty and stenting, and discuss the endovascular iliac recanalization in the presence of a persistent sciatic artery.

Wyburn-Mason syndrome associated with thyroid arteriovenous malformation: a first case report

A 31-year-old woman with a prior history of Wyburn-Mason syndrome, complicated previously by a left thalamic intracerebral hemorrhage at age 21, complained of sudden left vision loss due to a central retinal vein occlusion. Angiography revealed a left thyroid arterio-venous malformation (AVM) in addition to ones found intracerebrally. The pathogenesis and embryogenesis of this finding including the management of AVMs in Wyburn-Mason syndrome are discussed.