Surgical lobectomy of pulmonary arteriovenous malformations in a patient with presentations regarded as sequela of tuber
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(2020) 15:290
CASE REPORT
Open Access
Surgical lobectomy of pulmonary arteriovenous malformations in a patient with presentations regarded as sequela of tuberculosis: a case report Peng Teng, Weidong Li and Yiming Ni*
Abstract Background: Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions. Case presentation: We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86 to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl 3 months after surgery and the patient had been followed up for nearly 5 years. Conclusions: Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations. Keywords: Pulmonary arteriovenous malformation, Polycythemia, Cyanosis, Digital clubbing
Introduction Pulmonary arteriovenous malformations (PAVMs) represent an uncommon disease with a latest estimated incidence of approximately 1 in 2630 in population scanned by chest CT [1]. It was first described by Churton in 1897 [2]. Owing to the lack of intervening capillary bed, the patients with PAVMs have the predisposition to complications like hypoxemia, hemoptysis, ischemic stroke and cerebral abscess. Treatment is recommended to prevent later complications by embolization or surgical lobectomy. Herein, we * Correspondence: [email protected] Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79#, Qingchun Road, Hangzhou 310000, Zhejiang, China
report a 23-year-old male who presented with elevated hemoglobin which was initially treated as polycythemia vera on admission. His clubbed fingers and pulmonary lesion were misinterpreted as the sequela of previous tuberculosis (TB). Our case showed great learning value of differential diagnosis in patients with PAVMs. Furthermore, a brief literature review of PAVMs was performed.
Case report A 23-year-old male was admitted to the department of hematology because of elevated hemoglobin during routine check-up. Physical examination revealed digital clubbing, cyanosis of oral mucosa and extremities. Remarkable signs of laboratory work up included decreased
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