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J Thorac Cardiovasc Surg 2003;126:1204-1207
© 2003 The American Association for Thoracic Surgery

Brief communication

Combined endovascular and video-assisted thoracoscopic procedure for treatment of a ruptured pulmonary arteriovenous fistula: case report and review of the literature

Pierre-Yves Litzler, MDa,*, Françoise Douvrin, MDb, François Bouchart, MDa, Alfred Tabley, MDa, Ebticem Lemercier, MDb, Jean-Marc Baste, MDa, Michel Redonnet, MDa, Catherine Haas-Hubscher, MDc, Erick Clavier, MDb, Jean-Paul Bessou, MDa

a Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
b Department of Radiology, Rouen University Hospital-Charles Nicolle, Rouen, France
c Department of Anesthesiology, Rouen University Hospital-Charles Nicolle, Rouen, France

Received for publication March 13, 2003; accepted for publication April 24, 2003.

* Address for reprints: Pierre-Yves Litzler, MD, Department of Thoracic and Cardiovascular Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France
pierre-yves.litzler@chu-rouen.fr

The first 300 words of the full text of this article appear below.


Bessou, Clavier, Douvrin, Litzler (left to right)


A 35-year-old woman with a medical history of hereditary and recurrent epistaxis and lip telangiectasia was admitted with sudden left thoracic pain and dyspnea. There was no recent history of fever or thoracic trauma. Biologic data were as follows: hemoglobin level, 8.8 g/L; hematocrit level, 28%; oxygen saturation, 97%; and fraction of inspired oxygen, 10 L/min. Chest radiography and computed tomographic (CT) scanning revealed a left hemothorax with a suspicion of a vascular malformation in the left lower lobe (Figure 1). There were no aortic or pericardial abnormalities.


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  		Figure 1. Thoracic CT scan showing left hemothorax and lobulated opacity in the left lower lobe with uptake of contrast.

 
An intercostal drain was placed in the left pleural cavity, and 2000 mL of blood was drained, leading to a significant clinical improvement. Pulmonary angiography confirmed the presence of 2 arteriovenous fistulas in the upper part of the left lower lung and in the lingula (Figure 2). Rendu-Osler-Weber syndrome (ROW) was diagnosed on the basis of the patient's history and clinical and radiologic data.


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  		Figure 2. Pulmonary angiogram demonstrating PAVMs in the upper part of the left lower lobe (A) and in the lingula (B). The diameter of the segmental feeding artery of the lingula fistula was 5 mm.

 
Embolization of the lower lobe fistula was performed during general anesthesia with 3 Guglielmi Detachable Coils (Boston Scientific, Target Therapeutics, Fremont, Calif). One 3-dimensional shaped coil of 8 x 20 mm and 2 fibered coils of 6 x 20 mm and 4 x 20 mm, respectively, were placed with a 0.018-inch microcatheter (Boston Scientific, Target Therapeutics) in the feeding artery. Occlusion was completed with the injection of 0.3 mL of enbucrilate (Histoacryl; Braun Aesculap, Tuttlingen, Germany) emulsified with iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France). Catheterization . . . [Full Text of this Article]




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