肺动静脉瘘致反常脑栓塞一例

肺动静脉瘘(PAVF)是一种绕过肺毛细血管直接将肺循环与体循环连接起来的血管畸形,可单发或多发,下叶较上、中叶多见,其主要临床症状包括劳累后呼吸困难、发绀、咯血、栓塞等,可通过胸部X线、胸部CT、胸部CT血管成像(CTA)诊断。PAVF导致的反常性栓塞卒中通常伴有遗传性出血性毛细血管扩张症(HHT),引起反常脑栓塞的不伴有遗传性出血性毛细血管扩张症的单纯性肺动静脉瘘较少见。作者报道1例不伴HHT的单纯PAVF导致的反常性脑栓塞患者,该患者因突发右上肢无力且病情逐渐进展入院,MRI提示脑梗死,为查明栓子来源及确定治疗方案,对患者完善发泡实验及肺动脉CTA,结果显示为少见的单纯PAVF,治疗上行肺动脉封堵术并抗凝治疗后好转出院,提示当临床医师未明确栓子来源时,应将PAVF考虑在内。

A case of abnormal cerebral embolism caused by pulmonary arteriovenous fistula

Pulmonary arteriovenous fistula(PAVF)is a vessel malformation connecting the pulmonary circulation to the systemic circulation while bypassing the pulmonary capillaries,which could be single or multiple lesion and is more common in the inferior lobe of the lung compared with the upper and middle lobe of the lung.The clinical symptoms caused by PAVF include dyspnea after fatigue,cyanosis,hemoptysis,and embolism,which could be diagnosed by thoracic X-ray,computed tomography and computed tomography angiography.Moreover,The PAVF could lead to paradoxical cerebral infarction,which is often associated with hereditary hemorrhagic telangiectasia(HHT).Paradoxical cerebral embolism caused by PAVF without HHT is rare,accounting for 0.5%of all cerebral infarctions.Here,we report a patient who experienced an ischemic stroke caused by a paradoxical embolism with isolated PAVF and without HHT.The patient was admitted to our department because of the sudden-onset weakness of the right upper limb and the progressive deterioration.Magnetic resonance imaging(MRI)showed a cerebral infarction.The patient underwent pulmonary angiography and contrast transcranial Doppler to confirm the source of embolism.Finally,Simple PAVF without HHT was diagnosed.He was discharged from hospital after performed pulmonary artery occlusion and anticoagulation therapy.This case highlights that PAVF should be taken into account when clinicians do not know the source of embolism.