title: Hereditary hemorrhagic telangiectasia with growing pulmonary arteriovenous fistulas followed for 24 years.
abstract: A 47-year-old man was admitted for follow-up of an abnormal chest x-ray. He had a history of epistaxis and a brain abscess and a family history of pulmonary arteriovenous fistulas. Physical examination showed clubbed fingers and telangiectasia of the tongue. Laboratory data revealed evidence of polycythemia and hypoxia. Contrast echocardiography and pulmonary perfusion scintigraphy were suggestive of a right-to-left shunt. From the oxygen tension and content of blood taken at cardiac catheterization, the shunt ratio was calculated to be 57.8%. Multiple bilateral pulmonary arteriovenous fistulas were confirmed by angiography, and the patient was diagnosed as having hereditary hemorrhagic telangiectasia. A review of x-ray films taken over a 24-year period demonstrated that the fistulas in both lungs had been increasing gradually in size at different rates. A right lower lobectomy relieved the hypoxia, but the patient died unexpectedly on the twelfth postoperative day. There was no evidence of fistula rupture on chest film, but no autopsy was performed.
authors.affiliation: First Department of Internal Medicine, Osaka City University Medical School, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Teragaki
authors.forename: K
authors.initials: K
authors.lastname: Akioka
authors.forename: M
authors.initials: M
authors.lastname: Yasuda
authors.forename: Y
authors.initials: Y
authors.lastname: Ikuno
authors.forename: H
authors.initials: H
authors.lastname: Oku
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
authors.forename: T
authors.initials: T
authors.lastname: Takeda
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000235:genetics* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D011859:Radiography; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000235:genetics*