title: Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations and embolic strokes treated successfully with video-assisted thoracoscopic resection.
abstract: A 67-year-old hypoxic woman was admitted following two episodes of cerebral infarction. Based on the clinical presentation and radiological findings, a diagnosis of hereditary hemorrhagic telangiectasia was made and the cerebral ischemic complications were considered to have been caused by paradoxical embolizations related to pulmonary arteriovenous malformations (PAVMs). We performed video-assisted thoracoscopic surgery (VATS) and identified turbulent thrombi in one of the PAVMs that were capable of circulating systemically and inducing embolic strokes. The condition of the patient improved immediately following VATS. This case suggests that VATS may be a preferred therapeutic option in the treatment of patients with PAVM accompanying recurrent episodes of life-threatening complications such as strokes.
authors.affiliation: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akiyama
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hanada
authors.forename: Hironori
authors.initials: H
authors.lastname: Uruga
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takaya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Nasa
authors.initials: N
authors.lastname: Morokawa
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kurosaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujii
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000209:etiology / Q000601:surgery*; D002544:Cerebral Infarction / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology; D020766:Intracranial Embolism / Q000209:etiology* / Q000473:pathology; D010375:Pedigree; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities / Q000601:surgery*; D011859:Radiography; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors