[Pulmonary vascular manifestations in hereditary hemorrhagic telangiectasia]

Pulmonary arteriovenous malformation revealing Osler-Weber-Rendu disease: A case report

Osler-Weber-Rendu disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Pulmonary arteriovenous malformation is one of the main visceral complications revealing Osler-Weber-Rendu disease. The present case was a 34-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.

Pulmonary arterial hypertension in a patient with hereditary hemorrhagic telangiectasia and family gene analysis: A case report. World J Clin Cases 2021;9:3079-3089. [PMID: 33969094 PMCID: PMC8080754 DOI: 10.12998/wjcc.v9.i13.3079]

BACKGROUND

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant genetic disease. Very few patients suffering from HHT present with associated pulmonary arterial hypertension (PAH), which may result in a poor prognosis. Here, we report a case of HHT with PAH. The patient’s clinical manifestations and treatment as well as genetic analysis of family members are reviewed, in order to raise awareness of this multimorbidity.

CASE SUMMARY

A 45-year-old Chinese woman was admitted to the hospital to address a complaint of intermittent shortness of breath, which had lasted over the past 2 years. She also had a 30-year history of recurrent epistaxis and 5-year history of anemia. She reported that the shortness of breath had aggravated gradually over the 2 years. Physical examination discovered anemia and detected gallop rhythm in the precordium. Chest computerized tomography and cardiac ultrasound demonstrated PAH and hepatic arteriovenous malformation. The formal clinical diagnosis was HHT combined with PAH. The patient was treated with ambrisentan and her condition improved for a time. She died half a year after the diagnosis. Genetic testing revealed the patient and some family members to carry an activin A receptor-like type 1 mutation (c. 1232G>A, p. Arg411Gln); the family was thus identified as an HHT family.

CONCLUSION

We report a novel gene mutation (c. 1232G>A, p. Arg411Gln) in a Chinese HHT patient with PAH.

Bilateral heterochronic spontaneous hemothorax caused by pulmonary arteriovenous malformation in a gravid: a case report

Bilateral heterochronic spontaneous hemothorax as a result of pulmonary ateriovenous malformation is a very rarely happened disease. A 34-year-old woman presented major symptoms with right-sided chest pain and shortness of breath. The following contrast-enhanced computed tomographic scan of the chest showed a large amount of fluid in the right thorax with mediastinal shift, but without major vessel injury and 2 small dense opacities in the apical segment of the right lower lobe and in the posterior aspect of the left lower lobe. The patient underwent local resection of the right lower lobe. The pulmonary ateriovenous malformation was further identified by pathological examination. One month after she was discharged home, the symptoms described above recurred. A follow-up computed tomographic scan of the chest showed a large amount of fluid in the left thorax. During the emergency operation, we found a bullous lesion in the left lower lobe and a small blood vessel overlying the lesion that was actively bleeding. As stated above, local resection of the left lower lobe was performed once more. Pathological result was the same as observed previously. There were no postoperative complications and she was discharged from the hospital after two weeks. Two months later, she successfully delivered a healthy female infant. Up to now, regular follow-up observation has shown her to be perfectly asymptomatic.

Imaging modalities for retrieval of a migrated coil from the left ventricle, after pulmonary arterio-venous malformation embolisation

We present a case of a 62-year-old lady who was a known case of hereditary haemorrhagic telangectasia (Rendu-Osler-Weber syndrome) and had pulmonary arteriovenous malformations (AVMs). She had multiple embolisations of pulmonary AVMs. During the last embolisation therapy, one of the coils migrated into the heart. This could not be located by transoesophageal echocardiography, however, was identified in the left ventricle by computerised tomogram scan. It was removed successfully using cardiopulmonary bypass.