title: Pulmonary focal fibrosis associated with microscopic arterio-venous fistula manifesting as focal ground-glass opacity on thin-section CT.
abstract: BACKGROUND
  Focal ground-glass opacity (GGO) on thin-section computed tomography (CT) may be seen in atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ that has recently been renamed from bronchioloalveolar carcinoma (BAC) and various benign conditions.
  
  
  METHODS
  We report a case of pulmonary focal fibrosis associated with microscopic arterio-venous fistula (AVF), which showed a focal area of GGO on thin-section CT. The patient was a 58-year-old woman with a GGO on thin-section CT which had increased in size over the period of 2 years. Slightly dilated vessels and thickened interlobular septa were also noted around the GGO. It was diagnosed preoperatively as adenocarcinoma in situ and a partial lung resection by video-assisted thoracic surgery (VATS) was performed. Pathological examination yielded a diagnosis of focal fibrosis associated with microscopic AVF.
  
  
  CONCLUSIONS
  We speculate that the focal fibrosis was produced by a prolonged congestion due to the AVF and that the dilated vessels and thickening of interlobular septa on thin-section CT related to the AVF. Microscopic AVF may be one of the etiologies of focal fibrosis showing focal GGO on thins-section CT. Dilated vessels and thickened interlobular septa around the GGO might offer a clue to the diagnosis of this disease entity. In addition, it should be noted that focal fibrosis may increase in size.
authors: Department of Radiology, Teikyo University Mizonokuchi Hospital, 3-8-3 Mizonokuchi Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan. nonnon07@hotmail.co.jp
authors: Noriko
authors: N
authors: Sudo
authors: Atsushi
authors: A
authors: Nambu
authors: Takana
authors: T
authors: Yamakawa
authors: Masashi
authors: M
authors: Kawamoto
authors: Shozo
authors: S
authors: Fujino
authors: Masato
authors: M
authors: Watanabe
authors: Kunio
authors: K
authors: Mizuguchi
authors: Masao
authors: M
authors: Tago
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis; D001164:Arteriovenous Fistula / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*