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J Thorac Cardiovasc Surg 2004;127:574-576
© 2004 The American Association for Thoracic Surgery

Brief communication

Isolated pulmonary arteriovenous malformations requiring anatomic resection

^a Division of Cardiothoracic Surgery, University of California, San Francisco, Calif, USA
^b Division of Thoracic Anesthesia, University of California, San Francisco, Calif, USA
^c Division of Pulmonary Medicine, University of California, San Francisco, Calif, USA
^d Division of Pulmonary Pathology, University of California, San Francisco, Calif, USA

Received for publication September 3, 2003; accepted for publication October 8, 2003.

^* Address for reprints: Michael J. Mann, MD, Division of Cardiothoracic Surgery, UCSF Medical Center, 505 Parnassus Ave, Room M-593, San Francisco, CA 94143, USA
mannm@surgery.ucsf.edu

The first 20% of the full text of this article appears below.

Dr Mann

Pulmonary arteriovenous malformations (AVMs) are fistulous communications that are often part of a generalized syndrome and that can lead either to shunting or to hemoptysis. Identification and anatomic localization may allow selective embolization. Although this strategy can preserve lung parenchyma, resection may still be necessary to achieve adequate treatment of life-threatening complications. We present 2 cases of isolated pulmonary AVMs in which either the extent of disease or the need for prompt definitive treatment led to anatomic resection.

Clinical summaries

Patient 1
A 41-year-old woman with hemoptysis had undergone ligation of a persistent ductus arteriosus via a left thoracotomy at age 28. Chest computed tomography (CT) and bronchoscopy failed to identify the source of bleeding. She was hospitalized 1 month later with recurrent hemoptysis and underwent repeat CT and bronchoscopy, which did not localize the site of bleeding. Further evaluation of the right bronchial arteriography did not reveal evidence of a vascular abnormality. The left bronchial arteriography could not be assessed. The right bronchial vessels were embolized empirically, and the patient was discharged after a period of uneventful observation. She returned later that day, however, with hemoptysis that necessitated emergency isolation of the left lung with a double-lumen endotracheal tube. Repeat CT revealed a large amount of blood in the left pulmonary parenchyma and airways, with a possible focus of hemorrhage in the superior segment of the left lower lobe (Figure 1). Arterial blood gas, complete blood count, pro-time, partial thromboplastin time, and liver function test results were normal. Additional attempts at pulmonary and bronchial angiography failed to yield a source of hemorrhage. The patient was brought to the . . . [Full Text of this Article]