Congenital pelvic arteriovenous malformation

Our experience with congenital pelvic arteriovenous malformations is described. Presenting symptoms may be chronic and not always confined to the pelvis. Experience with arteriovenous malformations is limited. Preoperative angiography is essential to delineate the vascular supply to the lesion. Surgery has been successful in cases where complete tumor removal is performed. Careful long term follow-up is required for early detection of recurrence and follow-up angiography is recommended.     

Extradural thoracic arteriovenous malformation in a patient with Klippel-Trenaunay-Weber syndrome: case report

OBJECTIVE AND IMPORTANCE: Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION: A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3-T4 levels. INTERVENTION: The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1-T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION: KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.     

A case of pelvic arteriovenous malformation in a male

BACKGROUND: Congenital pelvic arteriovenous malformation (AVM) is rare especially in males. We present a case of pelvic AVM in a 38-year-old male. He was admitted to our hospital with left flank abdominal pain and painless gross hematuria. METHODS/DISCUSSION: Pelvic computed tomography demonstrated a homogeneous contrast-enhanced mass, 6 cm in diameter. For diagnosis, non-invasive magnetic resonance imaging (MRI) and color Doppler ultrasonography were very useful in our case. Though the treatment is controversial, we decided to monitor his clinical course.     

A case of pelvic arteriovenous malformation

Congenital pelvic arteriovenous malformation (AVM) is an uncommon lesion. This disorder occurs in female frequently than in male. A 44 year-old male complained of right lower abdominal discomfort and hemorrhoids. He had neither history of abdominal trauma nor abdominal surgery. A pulsatile mass was palpable on rectal digital examination and bruit was heard at right lower abdominal quadrant. Pelvic computerized tomogram showed an abnormal mass with homogeneous density near the right side of the bladder. The mass was equally enhanced by the contrast medium. Digital subtraction angiogram revealed the pelvic AVM which originate from right hypogastric artery. Selective angiogram showed many feeding arteries and a dilated vein. Surgical procedure was performed with transabdominal approach because this AVM was localized. All feeding arteries and aneurysmally dilated vein were completely removed. Post operative course was uneventful. Follow up arteriogram after the surgery showed no further abnormal arteriovenous connections.     

Pulmonary arteriovenous malformation in a patient with tuberculosis--an association?

We report a case of pulmonary arteriovenous malformation (PAVM) and associated pulmonary tuberculosis in a young girl who presented with hemoptysis. As intra-arterial coil embolization did not result in improvement of symptoms, surgical resection of the PAVM was performed, resulting in dramatic clinical improvement. Histopathology revealed a large PAVM, and in addition, caseous necrotizing granulomatous inflammation, suggestive of pulmonary tuberculosis. This case is being reported since the association of large PAVM and tuberculosis is very rare, and both could present with hemoptysis.     

Intraosseous arteriovenous malformation in a pediatric patient.

An isolated tibial intraosseous arteriovenous malformation was diagnosed in a seven-year-old boy. This malformation was not associated with any major clinical symptomatology except pain. It had a paucity of physical findings and was not well visualized with conventional radiography. It was not associated with any soft-tissue or cutaneous manifestations and it was entirely intramedullary, with minimal cortical involvement. This case illustrates the value of magnetic resonance imaging in the localization of these lesions. The absence of radiation exposure, coupled with the noninvasive nature, makes magnetic resonance imaging important in evaluating an intramedullary process in a pediatric patient.     

Hydrosalpinx in a patient with complex genitourinary malformation

We describe an adolescent female patient born with a complex genitourinary malformation including bilateral duplex system and duplication of the müllerian structures (bicornuate uterus and septate vagina). She presented with a symptomatic hydrosalpinx. The typical imaging of this condition is described along with the issues associated with the differential diagnosis in this complex scenario. The diagnosis of hydrosaplinx should be suspected in patients with complex genitourinary malformations and a pelvic fluid collection. Associated genital and renal anomalies are noted in 30% of cases.     

Resection of arteriovenous malformation in a patient with hemophilia type A

A 34-year-old man with hemophilia type A presented with a huge intracerebral hematoma (ICH) in the left frontoparietal lobe due to rupture of an arteriovenous malformation (AVM). Angiography demonstrated the AVM in the frontoparietal lobe fed by the anterior cerebral arteries and the middle cerebral arteries, with a vein draining into the superior sagittal sinus. He developed signs of cerebral herniation due to the huge ICH. An emergent operation was performed to reduce intracranial pressure and to stop bleeding from the AVM under continuous administration of factor VIII. To prevent postoperative hemorrhage, aggressive blood pressure control and continuous administration of factor VIII were performed for 10 days. His neurological status improved so that he could hold a simple conversation. Continuous administration of factor VIII during surgery and intensive intra- and postoperative therapy resulted in a favorable outcome for this patient with hemophilia type A.     

Congenital pelvic arteriovenous malformation with massive prostatic hemorrhage: a case report

Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.     

The determination of speech organization in a patient with an arteriovenous malformation

A case is reported of an arteriovenous malformation in the left motor speech area which was successfully excised without aphasia in a right-handed man. Preoperative sodium amobarbital carotid infusion testing demonstrated that the patient had right hemisphere dominance for speech. A review of the literature suggests that this is not an uncommon occurrence in individuals with congenital lesions of the left cerebral hemisphere. Lateralization of speech dominance should be established through definitive testing in these cases, especially if surgical removal of the malformation is contemplated.     

Large pelvic arteriovenous malformation complicating laparoscopic radical prostatectomy

Pelvic arteriovenous malformations (AVM) are rare, usually congenital, lesions, which can pose significant difficulties for pelvic surgeons. We present a case of an AVM complicating laparoscopic radical prostatectomy. Unexpected failure of preoperative control led to significant intraoperative difficulty. The advantages of an antegrade approach and optimal magnification afforded by the laparoscopic approach led to successful completion of the operation with minimal morbidity.     

Large congenital pelvic arteriovenous malformation and management options

The congenital pelvic arteriovenous malformation (AVM) arises from dysplastic arteries and veins. These rare conditions might present to the urologist by producing massive hematuria. Most AVMs can be controlled by surgical resection, usually in conjunction with preoperative angiographic embolization. Here, we present a case of a large pelvic AVM that caused significant patient morbidity and required treatment by novel methods after the usual means had failed. In this report, we will detail those unique interventions required to control a tenuous clinical situation.     

Two cases of congenital pelvic arteriovenous malformation in male

Congenital pelvic arteriovenous malformation(AVM) is extremely rare, especially in males. Herein we report two males with pelvic AVM. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated markedly dilated, and tortuous vessels in the pelvis in both patients. The first patient, a 77- year-old male, presented with difficulty in voiding and weak urinary stream. He was scheduled to have a prostate biopsy for suspicion of prostate cancer with pelvic lymph node swelling. However, the mass was diagnosed as pelvic AVM with MRI, and the prostate biopsy was cancelled. He has been followed conservatively since then. The second patient, a 55-year-old male, presented with gross hematuria which caused severe hemorrhagic hypovolemic shock. He had pelvic AVM, and he was treated with transcatheter arterial embolization two times. When patients with this disease present with general urological symptoms, urological procedures, without attention to this disease, might cause severe complications such as serious hemorrhage. We discuss the clinical course and the treatment for AVM, and review the literature.     

Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation

Purpose

Arteriovenous malformations (AVM) of the spinal cord are rare. We report the successful management of a patient with a cervical spinal cord AVM undergoing Caesarean section delivery, using a spinal anaesthetic.

Clinical features

Based on previous radiological investigations, the patient was known to have an AVM at the third cervical level of her spinal cord. After application of monitors and intravenous administration of 1 L normal saline, a 25 g Whitacre needle was inserted into the subarachnoid space at the L_3–4 interspace. Spinal anaesthesia was established with a solution consisting of hyperbaric spinal bupivacaine 12 mg, fentanyl 12.5 μg and epidural morphine 0.25 mg. There was no neurological deficit during hospital stay or after discharge.

Conclusion

The safe outcome of spinal anaesthesia for our patient is encouraging. The presence of spinal cord AVM at the cervical region is not an absolute contraindication to spinal anaesthesia.     

Anaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation

Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.