Asymptomatic arteriovenous malformation of the pancreas

Summary We reported a case of asymptomatic pancreatic AVM, incidentally found on routine ultrasonography and diagnosed noninvasively by means of Doppler ultrasonography and MRI. The diagnosis was confirmed by angiography. This is the first report to demonstrate the characteristics of pancreatic AVM by these two imaging techniques. They proved to be useful in identifying the vascular nature of AVM without the use of a contrast material, which is a definite advantage over DSA and CT. The quality of the image obtained was equivalent or superior to that obtained by DSA and contrast-enhanced CT. Doppler ultrasonography and MRI may serve as the primary imaging techniques of choice in suspected cases of AVM.     

Congenital coronary arteriovenous fistula: a diagnostic challenge

This report describes a case of coronary arteriovenous (A-V) fistula involving both the right and the left coronary arteries. The venous component of the two circulations combines into a single channel that empties into the left ventricle just below the mitral valve.     

Congenital pelvic arteriovenous malformation: An unusual cause of rectal pain

The differential diagnosis of rectal pain is extensive, and etiologies range from common anorectal disorders to more complex pelvic floor dysfunctional syndromes. The authors present a case of a man with rectal pain secondary to a congenital pelvic arteriovenous malformation. These malformations are rare and, to the authors' knowledge, have not been reported in association with rectal pain.     

case of arteriovenous malformation of the pancreas with Osler-Weber-Rendu disease]

A 58-year-old man with a complaint of sever epigastralgia was referred to our hospital. At a previous hospital, he had been initially diagnosis as having ruputured aneurysm of the head of the pancreas. A final diagnosis of arteriovenous malformation of the head of the pancreas by MDCT and abdominal angiogram, and underwent pancreatoduodenectomy. Major feeding arteries were the gastroduodenal artery and inferior pancreatoduodenal artery, and the major drainage vein was the gastrocolic trunk. This case was also diagnosed as Osler-Weber-Rendu disease because of the presense of three of the four criteria for this disease: habitual epistaxis, oral telangiectasia, and angiodysplastic lesion in the internal organ. This is the first reported case of arteriovenous malformation with Osler-Weber-Rendu disease in Japan.     

Congenital arteriovenous malformation rupturing into a true jejunal diverticulum

Massive hemorrhage from the gastrointestinal tract of an elderly patient due to a hitherto unreported cause is described. A congenital arteriovenous malformation located in the submucosa of a true jejunal diverticulum ruptured into the lumen. Both selective angiographic demonstration and histologic documentation of the bleeding point are presented. The simultaneous presence of these two entities is probably not a coincidence and is discussed.     

Congenital giant arteriovenous malformation in a 31-year-old male

In this case presentation we report the history of a 31-year-old male suffering from a congenital giant arteriovenous malformation (AVM) of the neck and the right chest wall over the course of 12 years. This vascular tumor was fed by dilated arteries, branches of the right external carotid, and both subclavian arteries. The first therapeutic procedure was an isolated ligation of the draining arteries, which was not successful as angiography showed two years later. As the patient rejected any further therapy, the enormous growing tumor was again treated 9 years later. At this time an interdisciplinary management involving radiologists and surgeons was arranged. Superselective embolization preceding surgical radical tumor resection was performed. After a follow-up period of almost 1 year no further signs of progression were seen, except the postsurgical embolization of one collateral external carotid branch and a beginning skin necrosis which was to be expected. However, recently progression has become evident, but the patient has refused further treatment.     

Case report of asymptomatic arteriovenous malformation (AVM) of the pancreas; diagnostic advantage of three-dimensional computed tomography]

A 72-year-old man with diabetes mellitus and hypertension was admitted for further examination and therapy of diabetes. In order to evaluate his pancreas, abdominal computed tomography (CT) was performed, showing a space-occupying lesion (SOL) in the pancreatic uncus. He did not show any symptoms related to the pancreas or gastro intestinal tract. Three-dimensional CT (3D-CT) indicated that the SOL was not a solid tumor but a vessel fistula, fed by the superior mesenteric artery and the gastro duodenal artery, drained by the superior mesenteric vein. Abdominal angiography also showed its peculiar vessel structure, confirming arterio-venous (A-V) malformation in the pancreas. Pancreatic A-V malformation is a rare condition but should not be forgotten in the differential diagnosis of pancreatic SOL. Our case showed the advantages of 3D-CT with its low invasiveness and convenience for the diagnosis of A-V malformation in the pancreas.     

胼胝体动静脉畸形的临床特点和手术疗效

目的探讨胼胝体动静脉畸形（AVM）的临床特点和手术疗效。方法对2005年9月—2011年8月收治的7例胼胝体AVM患者进行手术治疗。AVM分别位于胼胝体膝部1例,体部额段3例,体部顶段1例,压部2例。5例有脑室出血,对其中1例发生脑疝的患者行急诊手术。对膝部AVM经冠状切口单额开颅,行血肿清除及AVM切除术;对体部额段AVM患者,经前纵裂及额叶皮质造瘘后,经侧脑室切除AVM及清除血肿;对体部顶段AVM及压部AVM患者,经纵裂及顶叶切除AVM。结果①6例患者为中型AVM,最大直径为3～4.5 cm,1例为小型AVM,最大直径为2.5 cm。AVM由胼周动脉、胼缘动脉、后胼周动脉及脉络膜后内侧动脉供血。3例单纯浅静脉引流,2例深静脉引流,2例深、浅静脉同时引流。②7例患者的畸形血管团均获得全切。5例恢复良好,其中2例术后一过性肌力下降,1例出现偏瘫,4～14 d后恢复正常。1例术前脑疝患者术后6个月意识逐渐恢复。1例术中大出血病例术后发生脑积水,行脑室-腹腔分流术,术后意识清楚,遗留四肢痉挛性瘫痪、肌张力增高。③术后对6例行DSA或CTA复查,AVM消失,1例未复查。④临床随访3个月至6年,末次随访时,GOS评分为5分的5例,3分的2例。结论胼胝体AVM位置深在,供血动脉、引流静脉复杂,合理手术入路有助于完全切除AVM,术后疗效较好。     

儿童颅内动静脉畸形的临床特点及手术治疗

年龄是影响颅内动静脉畸形（aneriovenous malformation,AVM）患者手术预后的重要因素。有研究表明,儿童患者的手术预后优于成人患者。但也有研究者提出不同观点,认为儿童患者的治愈率低,死亡率更高。原因可能与其总结病例较早（1980年）或者手术病例的选择有关。本研究回顾性分析接受神经外科手术治疗的儿童AVM患者的临床资料,期望对这一年龄段的AVM患儿加深认识,有助于对该类患儿的诊治。     

对脑动静脉畸形的若干思考

1895年，Steinheil首先描述了脑动静脉畸形（cerebral arteriovenous malformation，CAVM）。此后随着影像学技术、工艺材料的发展和临床经验的积累，现代医学对CAVM的流行病学、自然病史、发生机制、病理学、临床表现以及治疗学已有更深刻的认识。而对现代意义的CAVM的认识始于Cushing和Dandy，他们在逻辑上将脑血管畸形进行了分类，并制定了相应的治疗策略。脑血管畸形可分为多种类型，临床上以CAVM最为常见。     

Management of pancreatic arteriovenous malformation

Pancreatic arteriovenous malformations (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. The elimination of pancreatic AVM is difficult once portal hypertension has developed. We describe herein a patient with congenital AVM of the pancreatic head presenting with recurrent episodes of melena, in whom pylorus-preserving pancreatoduodenectomy provided a means of definitive management. We also review the literature and focus on the diagnostic and therapeutic approaches. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage.     

Pulmonary arteriovenous malformation: two sibling cases

Pulmonary arteriovenous malformations, are abnormal connections between pulmonary arteries and veins. However it can be presented as an isolated single anomaly, also may be multiple when accompanying with autosomal dominant hereditary hemorrhagic telengiectasia (Rendu-Osler-Weber Syndrome; ROWS). In this case report, two patients operated with the diagnosis of multiple pulmonary arteriovenous malformation familial screening done with the possibility of ROWS and pulmonary arteriovenous malformation found in her sister, are presented.     

Congenital pulmonary airway malformation: CT-pathologic correlation

OBJECTIVES: Congenital pulmonary airway malformation (CPAM) is classified into 5 subtypes (types 0 to 4). We attempted to correlate computed tomography (CT) findings with those of pathologic examination and evaluated the predictability of the CPAM subtype. SUBJECTS AND METHODS: We retrospectively reviewed CT findings in 13 pathologically proven cases of CPAM seen between 1981 and 2005. Patient's age ranged from 4 days to 5 years and 10 months. Six were boys and 7 were girls. According to CT findings, lesions with a cyst larger than 2.5 cm, lesions with cysts 2.5 cm or less and solid lesions were classified into groups A, B, and C, respectively. We assumed that Stocker's types 1 and 4, type 2, and types 0 and 3 would correspond to CT groups A, B, and C, respectively. Then, we assessed whether this assumption is correct or not. RESULTS: Eight, 3, and 2 cases were diagnosed as groups A, B, and C, respectively. All of the 8 cases diagnosed as group A were Stocker's type 1. One of the 3 cases diagnosed as group B was type 2, but the remaining 2 were type 1 and type 4, respectively. One of the 2 cases diagnosed as group C was type 3 but the other was type 2. CONCLUSIONS: Lesions with the largest cyst being larger than 2.5 cm was type 1. It seemed, however, difficult to distinguish among types 1, 2, and 4 when they consisted of small cystic components and between types 2 and 3 when they appeared as a solid lesion.     

Giant renal arteriovenous malformation: a suspicious bruit

Arteriovenous (AV) malformations remain relatively rare clinical lesions consisting in abnormal shunts between the arterial and venous vascular systems. Both,congenital or acquired fistulas, are unusual causes of renal or heart failure. Congenital AV fistulas usually present with hematuria, while acquired ones are more likely to present with hemodynamic changes, such as hypertension, cardiomegaly and congestive heart failure. Here we present a 61 year-old woman studied before by probable pulmonary arteriovenous fistula and referred to nephrologist with a six-month history of dyspnea and peripheral edema. Physical examination was remarkable for an apical systolic ejective murmur as well as another bruit over the right pulmonary base. Blood tests showed a sCr of 1.7 mg/dl with normal urinalysis. On imaging, renal duplex ultrasound showed a pulsatile hiliar mass on the right kidney with an arterial flow of 300 cm/sec that was identified as a giant AV fistula on MRA. An echocardiogram revealed severe pulmonary hypertension with a cardiopulmonary output of 12,9 l/min that doubled the systemic one (6,49 l/min). In view of the large size of the AV fistula occupying the majority of the parenchyma, endovascular approach was turned down and a laparoscopic nephrectomy was performed successfully. There was an immediate clinical improvement and 45 days after the procedure, a control-echocardiogram showed normalization of the cardiopulmonary parameters with minimal changes in glomerular filtration rate.