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Hou H, Guo C, Que C, Nie L, Zhang Q, Zhao H, Nong L, Ma W, Wang Q, Liang Z, Wang B, Ma J, Wang G. Diffuse large B-cell lymphoma presenting as reversible intrapulmonary arteriovenous shunts with hypoxia, fever and progressive jaundice: a case report and literature review. BMC Pulm Med 2022; 22:89. [PMID: 35292006 PMCID: PMC8922084 DOI: 10.1186/s12890-022-01881-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Intrapulmonary arteriovenous shunts is rare seen in a patient without lung involvement. Case presentation This is the first report of reversible intrapulmonary arteriovenous shunts secondary to extrapulmonary lymphoma as one initial symptom. The patient presented as fever of unknown origin and dyspnea, and examinations of infection were negative. Diagnosis of DLBCL was finally confirmed through bone marrow and splenic biopsies. Intrapulmonary arteriovenous shunts were diagnosed through 100% oxygen inhalation test and transthoracic contrast echocardiography (TTCE). After the treatment of lymphoma, his respiratory failure was relieved. We rechecked the 100% oxygen inhalation test and TTCE, which both indicated that his intrapulmonary arteriovenous shunts had resolved. Conclusions We speculated the prominent inflammation from active DLBCL was the most possible mechanism associated with the reversible intrapulmonary shunt in this patient. These findings will assist us to better understand the mechanism of intrapulmonary shunts.
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Affiliation(s)
- Huan Hou
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Cuiyan Guo
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chengli Que
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Ligong Nie
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Qi Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hong Zhao
- Department of Infectious Diseases, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Zeyin Liang
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Bingjie Wang
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
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Cardosa MF, Mingas O, Ramos R, Araújo AR. Persistent hypoxaemia after a pneumonia: a rare cause to consider. BMJ Case Rep 2021; 14:14/5/e241491. [PMID: 33975841 PMCID: PMC8117980 DOI: 10.1136/bcr-2020-241491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Odete Mingas
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Rita Ramos
- Department of Pediatrics, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ana R Araújo
- Department of Pediatric Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Chadia K, Ntolios P, Anevlavis S, Steiropoulos P. Lung Nodules and Hypoxemia: Any Association? Cureus 2021; 13:e13880. [PMID: 33868844 PMCID: PMC8043568 DOI: 10.7759/cureus.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) consist of aberrant circulation between pulmonary arteries and veins causing right-to-left shunt, uncommon and asymptomatic in the general population. We presented two patients, one presented with unexplained dyspnea and disease limited to the lung and the other with neurologic signs and systematic disease. Both patients were diagnosed with arteriovenous malformations and received embolization treatment successfully. Both patients received embolization treatment successfully.
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Affiliation(s)
- Konstantina Chadia
- Pulmonology, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Paschalis Ntolios
- Pulmonology, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Stavros Anevlavis
- Pulmonology, University Hospital of Alexandroupolis, Alexandroupolis, GRC
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Keinath K, Vaughn M, Cole N, Gentry S. Exertional hypoxia in a healthy adult: a pulmonary arteriovenous malformation. BMJ Case Rep 2019; 12:12/10/e231981. [PMID: 31645384 DOI: 10.1136/bcr-2019-231981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are a rare cause of pulmonary symptoms, including dyspnoea on exertion, hypoxemia and haemoptysis. PAVMs are an aetiology that is often overlooked by physicians when developing a differential diagnosis for pulmonary symptoms and unidentified lung masses. However, it is an important differential diagnosis to have as PAVMs can have serious sequelae including strokes, brain abscess and life-threatening bleeding. We present a case of an impressive PAVM presenting with chest pain, chronic cough, feelings of anxiety, mild resting hypoxemia and exertional hypoxemia. Of note, on previous chest X-ray, 8 years prior to presentation, an incidental mass was found during a shoulder repair presurgical workup but not further evaluated.
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Affiliation(s)
- Kyle Keinath
- Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Megan Vaughn
- Department of Medicine, BUMED, Falls Church, Virginia, USA
| | - Nathan Cole
- Department of Medicine, BUMED, Falls Church, Virginia, USA
| | - Shari Gentry
- Department of Medicine, BUMED, Falls Church, Virginia, USA
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Barbaryan A, Bailuc S, Raqeem MW, Kak M, Derani L, Mirrakhimov AE. Wake-Up Call: Pulmonary Arteriovenous Malformation. Am J Med 2017; 130:290-292. [PMID: 27888050 DOI: 10.1016/j.amjmed.2016.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Aram Barbaryan
- Department of Internal Medicine, University of Kansas Medical Center.
| | - Stefania Bailuc
- Department of Internal Medicine, HSHS Saint Mary's Hospital, Decatur, Ill
| | | | - Manisha Kak
- Department of Neurology, University of Chicago Medical Center, Ill
| | - Lena Derani
- Department of Neurology, University of Chicago Medical Center, Ill
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Qaiser I, Nayani K, Ahmed S, Ali R, Atiq M. Sarcoidosis with Arteriovenous Malformation in a 15-Year-Old Girl - The Rarest of the Rare. Front Pediatr 2015; 3:77. [PMID: 26442237 PMCID: PMC4585201 DOI: 10.3389/fped.2015.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Sarcoidosis is an uncommon multi-system disorder with many possible complications. Arteriovenous malformations (AVMs) are a rare vascular complication of sarcoidosis. CASE DESCRIPTION A 15-year-old girl presented to the Pediatric Clinic at AKUH with pulmonary, hepatic, joint, and skin manifestations. Physical examination and investigations pointed toward sarcoidosis, including raised erythrocyte sedimentation rate, angiotensin converting enzyme (ACE), and alanine transaminase (ALT). An incidental finding of pulmonary arteriovenous malformation (PAVM) was noticed on echocardiography. She responded to oral corticosteroids, her ACE and ALT levels improved. There was lack of indication for pulmonary angio-embolization for her PAVM. On a 3-year follow-up, her condition improved and she is clinically well. DISCUSSION Pulmonary arteriovenous malformation is an extremely rare complication of sarcoidosis, especially among the pediatric population. Hence, this is the first reported case of its kind. The relation between sarcoidosis and PAVM is difficult to establish; however, there are some theories. This condition may be treated depending on the symptoms. Since our patient did not have any significant symptoms of PAVM, she was treated for the underlying disease, i.e., sarcoidosis. CONCLUSION While dealing with patients having multi-system disorders like sarcoidosis, one must be very vigilant so as not to miss out on any complication. Regular follow-up visits should be scheduled to rule out new complications and to monitor the past ones.
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Affiliation(s)
- Iman Qaiser
- Medical College, Aga Khan University , Karachi , Pakistan
| | - Kanwal Nayani
- Medical College, Aga Khan University , Karachi , Pakistan
| | - Shakeel Ahmed
- Department of Pediatrics, Aga Khan University , Karachi , Pakistan
| | - Rehan Ali
- Department of Pediatrics, Aga Khan University , Karachi , Pakistan
| | - Mehnaz Atiq
- Department of Pediatrics, Aga Khan University , Karachi , Pakistan
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Romero R. Liver in congenital heart disease: Implications of the fontan procedure for pediatric and adult liver specialists. Clin Liver Dis (Hoboken) 2013; 2:210-214. [PMID: 30992865 PMCID: PMC6448652 DOI: 10.1002/cld.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- René Romero
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of PediatricsEmory University School of MedicineAtlantaGA
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Halank M, Ewert R, Seyfarth HJ, Hoeffken G. Portopulmonary hypertension. J Gastroenterol 2006; 41:837-47. [PMID: 17048047 DOI: 10.1007/s00535-006-1879-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 07/25/2006] [Indexed: 02/04/2023]
Abstract
Portopulmonary hypertension (PPHT) is defined as precapillary pulmonary hypertension accompanied by hepatic disease or portal hypertension. Pulmonary hypertension results from excessive pulmonary vascular remodeling and vasoconstriction. These histological alterations have been indistinguishable from those of other forms of pulmonary arterial hypertension. Factors involved in the pathogenesis of PPHT include volume overload, hyperdynamic circulation, and circulating vasoactive mediators. The disorder has a substantial impact on survival and requires focused treatment. Liver transplantation in patients with moderate to severe PPHT is associated with a significantly reduced survival rate. The best medical treatment for patients with PPHT is controversial; most authors currently regard continuous intravenous application of prostacyclin as the treatment of choice for patients with severe PPHT. There is only very limited reported experience with inhaled prostacyclin or its analog, iloprost. Increasing evidence of the efficacy of the endothelin-receptor antagonist bosentan and of the phosphodiesterase-5 inhibitor sildenafil is emerging in highly selected patients with PPHT. In the future, a combination therapy of the above-mentioned agents might become a therapeutic option. Other agents such as beta-blockers seem to be harmful to patients with moderate to severe portopulmonary hypertension. Up-to-date, randomized, double-blind, controlled clinical trials are lacking and are needed urgently.
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Affiliation(s)
- Michael Halank
- Carl Gustav Carus University Dresden, Internal Medicine I, Fetscherstr. 74, 01307 Dresden, Germany
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Ramsay MA. Portopulmonary Hypertension and Hepatopulmonary Syndrome, and Liver Transplantation. Int Anesthesiol Clin 2006; 44:69-82. [PMID: 16832207 DOI: 10.1097/01.aia.0000210800.60630.ac] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Michael A Ramsay
- Department of Anesthesiology, Baylor University Medical Center, Dallas, TX 75246, USA
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10
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Taillé C, Cadranel J. [The respiratory physician, the lung, and the liver]. Rev Mal Respir 2004; 21:457-9. [PMID: 15292835 DOI: 10.1016/s0761-8425(04)71347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Altintas E, Akkus N, Gen R, Helvaci MR, Sezgin O, Oguz D. Effects of terlipressin on systolic pulmonary artery pressure of patients with liver cirrhosis: An echocardiographic assessment. World J Gastroenterol 2004; 10:2278-80. [PMID: 15259082 PMCID: PMC4724967 DOI: 10.3748/wjg.v10.i15.2278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Portopulmonary hypertension is a serious complication of chronic liver disease. Our aim was to search into the effect of terlipressin on systolic pulmonary artery pressure among cirrhotic patients.
METHODS: Twelve patients (6 males and 6 females) with liver cirrhosis were recruited in the study. Arterial blood gas samples were obtained in sitting position at rest. Contrast enhanced echocardiography and measurements of systolic pulmonary artery pressure were performed before and after the intravenous injection of 2 mg terlipressin.
RESULTS: Of 12 patients studied, the contrast enhanced echocardiography was positive in 5, and the positive findings in contrast enhanced echocardiography were reversed to normal in two after terlipressin injection. The mean systolic pulmonary artery pressure was 25.5 ± 3.6 mmHg before terlipressin injection, and was 22.5 ± 2.5 mmHg after terlipressin (P = 0.003). The systolic pulmonary artery pressure was above 25 mmHg in seven of these 12 patients. After the terlipressin injection, systolic pulmonary artery pressure was < 25 mmHg in four of these cases (58.3% vs 25%, P = 0.04).
CONCLUSION: Terlipressin can decrease the systolic pulmonary artery pressure in patients with liver cirrhosis.
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Affiliation(s)
- Engin Altintas
- Mersin Universitesi Tip Fakultesi Hastanesi Ic Hastaliklari A.D., 33079 Mersin, Turkiye.
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