Pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia.
Pulmonary arteriovenous malformations (PAVMs) associated with hereditary hemorrhagic telangiectasia may cause severe cerebral complications that may be prevented by embolization therapy. We retrospectively compared the diagnostic value of noninvasive tests for the screening of treatable (amenable to embolization) PAVMs in a series of 105 patients, using chest computerized tomography (CT) and/or pulmonary angiography as a "gold standard." Patients had assessment of dyspnea, chest radiograph, alveolar-arterial PO2 gradient under 100% oxygen (AaPO2), contrast echocardiography, and radionuclide perfusion lung scanning. Contrast echocardiography in the supine position was the most sensitive test (93%). The sensitivity of self-reported dyspnea (59%), chest radiograph alone (70%), measurement of AaPO2 by the 100% oxygen method (62%), or radionuclide lung scanning (71%), was not suitable for efficient screening. A 100% sensitivity and negative predictive value could be obtained when combining anteroposterior chest radiograph and contrast echocardiography. Our data support a screening algorithm based on the combined use of contrast echocardiography and anteroposterior chest radiograph, followed by chest CT if either test is positive. An alternative is to screen directly by chest CT. However, this algorithm may obviate the need for chest CT in patients without PAVM, who represent a majority of patients with hereditary hemorrhagic telangiectasia.
Cottin
Vincent
V
Service de Pneumologie, Centre des Maladies Orphelines Pulmonaires, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Université Claude Bernard, 69677 Bron Cedex, France. vincent.cottin@chu-lyon.fr
Plauchu
Henri
H
Bayle
Jean-Yves
JY
Barthelet
Martine
M
Revel
Didier
D
Cordier
Jean-François
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015901:Angiography, Digital Subtraction / Q000592:standards*; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D003663:Decision Trees; D004452:Echocardiography / Q000592:standards*; D004621:Embolization, Therapeutic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D015995:Prevalence; D011651:Pulmonary Artery / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*; D014057:Tomography, X-Ray Computed / Q000592:standards*
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin