DÄ internationalArchive20/2019Pulmonary Arteriovenous Malformation

Clinical Snapshot

Pulmonary Arteriovenous Malformation

Dtsch Arztebl Int 2019; 116(20): 364; DOI: 10.3238/arztebl.2019.0364

Klein, M; Kundel, C; Brandl, R

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1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt
1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt
Figure
1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt

A 28-year-old previously healthy woman in the third trimester of pregnancy presented with hemoptysis (“mouth repeatedly full of blood”). Bronchoscopy showed diffuse right bronchial bleeding associated with transient gas-exchange disorder. Clinical examination revealed a low likelihood of pulmonary embolism, duplex sonography of the leg veins was negative, and echocardiography showed no abnormalities. Despite the patient’s pregnancy we carried out contrast-enhanced thoracic computed tomography to detect, for example, any pulmonary vascular malformation. A shunt between the right bronchial artery and the pulmonary vein, visualized due to suboptimal contrast enhancement, was treated with catheter-assisted coiling. The bleeding ceased, and 10 weeks later the patient gave birth to a healthy girl. Rupture of a pulmonary arteriovenous malformation (PAVM) is a life-threatening event that occurs more frequently during pregnancy. Hormone-induced angiogenesis has been proposed as a possible cause. There have been only few reports of PAVMs from bronchial arteries. In our patient the malformation would probably have gone undetected if the contrast enhancement had not been inadequate. Because of its exposure to contrast medium, the newborn child should undergo thyroid function testing.

Dr. med. Manuel Klein, Dr. med. Roland Brandl, Dr. med. Christof Kundel, Krankenhaus Barmherzige Bruder Regensburg, Pneumologie und konservative Intensivmedizin, manuelklein@live.de

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Klein M, Brandl R, Kundel C: Pulmonary arteriovenous malformation. Dtsch Arztebl Int 2019; 116: 364. DOI: 10.3238/arztebl.2019.0364

1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt
1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt
Figure
1) Aorta; 2) right bronchial artery; 3) right pulmonary vein (upper lobe); 4) shunt