Pulmonary arteriovenous malformation causing massive haemoptysis and complicated by coronary air embolism.
We report the case of a 20-year-old man with possible Osler-Rendu-Weber syndrome (hereditary haemorrhagic telangiectasia) who developed an episode of massive haemoptysis from a bleeding pulmonary arteriovenous malformation in the left lower lobe of his lung. During the acute haemorrhage, he also appeared to suffer a coronary air embolism, possibly due to introduction of air into the bleeding arteriovenous malformation during intermittent positive pressure ventilation through the endotracheal tube. His electrocardiogram showed extensive ST elevation (>2 mm) in the inferolateral leads associated with raised troponin I and creatine kinase levels. These changes resolved within thirty minutes. The pulmonary arteriovenous malformation was successfully treated with a combination of alcohol injection and coil embolization.
Loke
G P Y
GP
Department of Anaesthesia, Austin Health, Heidelberg, Victoria.
Story
D A
DA
Liskaser
F
F
Seevanayagam
S
S
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016638:Critical Illness; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy