A Rare Case of Pulmonary Vascular Anomaly: MDCT Pulmonary Angiography in Diagnosis of Arteriovenous Malformation and Post-operative Imaging

Abstract

Objective. To demonstrate the diagnostic algorithm and tactics of a surgical management of patients with pulmonary arteriovenous malformations.Materials and Methods. Based on a patient`s clinical data analysis, further examination tactic was chosen: in the pre and postoperative periods multispiral computed tomography (MSCT) angiopulmonography (on a Canon Aquillion Prime, Japan) was performed before and after intravenous administration of a iodine-containing contrast agent (Ultravist, 370 mg/ ml) at the rate of 1 ml/kg. Brain magnetic resonance tomography was performed on a Signa Voyager, General Electric, China, 1,5 Tl in the pulse sequences T1, T2, T2 FLAIR, DWI, SWAN in three mutually perpendicular planes with a slice thickness of 1-5 mm to examine the neurological complications. Interventional angiopulmonography was implemented by using General Electric Innova IGS530, France, angiographic system before and after endovascular occluder ("AMPLATZER Vascular PLUG 4", USA) and spirals ("2D-Helical-35" 9 mm in diameter and 2,7 mm long (4 spirals) and "Complex–Helical-18" 11 mm in diameter and 17 mm long, USA) placement. A literature review in Russian and English languages for the last 5 years was searched using CyberLeninka, PubMed Central, Elibrary data bases, by keywords: pulmonary arteriovenous malformation, MSCT angiopulmonography, endovascular treatment. The prospective longitudinal study was conducted in compliance with the principles of ethics in accordance with the Helsinki Declaration, and informed voluntary consent was obtained from the patient.Results. According to clinical and instrumental data, the tactics of combined endovascular treatment of a vascular malformation with subsequent postoperative control was collectively chosen. During the curation, an increase in saturation parameters, general wellbeing improvement, decrease in pulmonary pressure parameters, and diminution in the size of the right heart's parts were achieved.Conclusion. Arteriovenous malformations (AVMs) are rare vascular abnormalities that represent a pathological communication between the arterial and venous bed. The fistulous link leads to an abnormal discharge of blood, bypassing the physiological capillary channel. Radiation and interventional visualization methods play the most important diagnostic, and the latest — therapeutic role in management of patients and are able to establish indications for surgical intervention, prevent the occurrence of life-threating complications: abscesses, paradoxical embolism and heart attacks, progressive respiratory and heart failure.