Objective To investigate the clinical characteristics and treatment for Type II pulmonary vascular anomaly ( pulmonary arteriovenous malformations) of hepatopulmonary syndrome ( HPS)presenting with hemothorax. Methods A case of Type II pulmonary vascular anomaly of HPS presenting with recurrent hemothorax was described. The clinical data was analyzed and the related literature was reviewed. Results A 72-year-old male patient with Type II pulmonary vascular dilatations of HPS was described to present with recurrent dyspnea and encapsulated pleural effusions. After 4 procedures of thoracentesis, a total of 2510 mL of bloody pleural effusions was drained. The routine analysis of pleural fluid showed the count of red cells exceeded 100 ×109 / L, whereas cytologic examination and tumor biomarkers were negative. Then CTPA and pulmonary angiogramrevealed a Type II pulmonary vascular anomaly of HPS combined with hemothorax. The PaO2 of arterial blood in upright and supine position was 58. 3 mm Hg and 66. 3 mm Hg, respectively. Hypoxemia was alleviated and hemothorax was controlled after embolization of malformed blood vessels. Fromliterature review, similar cases of hemothorax resulted fromrupture of Type II pulmonary vascular anomaly of HPS were not reported. The primary clinical manifestations of HPS were dyspnea and cyanosis. Orthodeoxia and platypnea were most consistent with HPS. The best screening tool for hypoxemia in patients with HPS was P( A-a) O2. The characteristic findings of HPS on chest CT was a lesion or reticulonodular opacities occurring predominantly in the bases of the lungs, which could be enhanced by contrast medium. Pulmonary angiogram was necessary to identify the types of pulmonary vascular dilatations. Hepoxemia of patients with Type II HPS often responded poorly to oxygen therapy, whereas embolization of the pulmonary arteriovenous fistulas was helpful to improve anoxia. Conclusions Rupture ofType II pulmonary vascular malformations in HPS was a rare cause of hemothorax. Thrombosis of pulmonary arteriovenous malformations may result in significant improvement in oxygen saturations as well as control of hemothorax. In the setting of liver disease, intrapulmonary vascular dilatations and hypoxemia often suggestthe existence of HPS.
摘要:目的: 評估手術、栓塞及γ刀綜合治療腦動靜脈畸形的療效。 方法 :回顧性分析了我科自2002年3月至2009年7月期間綜合治療的43例腦AVM患者,分析評估這43例腦AVM的臨床特點及治療效果,隨訪患者并對其進行GOS評分。 結果 :本組病例采取栓塞＋手術治療3例、栓塞＋γ刀治療26例、手術＋γ刀治療11例、栓塞+手術＋γ刀治療3例。術后隨訪28例,隨訪時間4月至7年6月,GOS評分5分者25例,患者均能重新回到工作或學校;GOS評分4分者2例,患者生活能夠自理;GOS評分1分者1例,患者死亡。 結論 :對大型、功能區、有深部靜脈引流的腦AVM綜合治療有一定的優越性,它不僅使腦AVM治愈率明顯提高,而且與治療相關的各種并發癥和病死率也明顯降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
Both Dyna CT, a rotational faultage reconstructed technique, and digital subtraction angiography (DSA) play important roles in the diagnosis and treatment of arteriovenous malformations (AVM). Three-dimensional Dyna CT can provide the spatial information of AVM nidus, while two-dimensional DSA can provide the time information for distinguishing arteries and veins. To illustrate the location relationship of the nidus, arteries and veins at the same time, these two imaging modalities need to be fused. In this paper, a two-dimensional to three-dimensional back projection and growing method is proposed, which realizes the image fusion of two-dimensional DSA and three-dimensional Dyna CT and achieves the differentiation of arteries and veins in Dyna CT. The experimental results showed that the fusion image could present both the position information of AVM nidus and the dynamic information of the blood vessels. Therefore, the proposed method can help surgeons locate the AVM abnormality and make operation plan more accurately.