Clinical example of surgical treatment of arteriovenous malformation in right thoracoscopic lobectomy

Abstract

Pulmonary arteriovenous malformations are a rare congenital pathology observed in 2–3 individuals per 10,000, and 10 % of cases are diagnosed in children in the first several years of life. Arteriovenous malformations are vascular abnormalities of the cardiovascular system presenting as pathological anastomoses (shunts) between the arterial and venous systems which leads to direct shunting of nonoxygenated blood from the arterial bed into the venous bed bypassing pulmonary capillary network. Frequently, diagnosis of pulmonary arteriovenous malformations is made in rather neglected cases. Pulmonary arteriovenous malformations is hard to diagnose and treat, therefore it requires special attention from surgeons and clinicians which prompted us to describe a clinical case of a young 27-year old male patient with signs of significant chronic hypoxia (saturation (SpO2 ) – 84–86 %, hemoglobin level – 185 g/L, erythrocyte count – 6.13 million/μL, hematocrit – 51.8 %; during examination: acrocyanosis, nail clubbing; complaints of vertigo, decreased tolerance of physical activity, breathlessness during physical activity). Computed tomography in the S8, S9 segments showed arteriovenous malformation, size about 70 × 70 mm. Patient underwent radical treatment in the form of right lower thoracoscopic lobectomy which led to an immediate increase in oxygen saturation (SpO2 ) to 99 %. This clinical example shows that surgical method of treatment is the most radical, and thoracoscopic intervention in a young patient significantly decreases the volume of injury and promotes quick recovery and return to active life.