Pulmonary arteriovenous malformation-etiology, clinical four case presentations and review of the literature.
Pulmonary arteriovenous malformation (PAVM) is a rare clinical condition with abnormal direct communication between the branches of pulmonary artery and vein. It may occur as an isolated anomaly or in association with hereditary hemorrhagic telangiectasia (HHT). Although these vascular pulmonary pathologies are quite uncommon, they are the important part of the differential diagnosis of common pulmonary problems such as hypoxemia and pulmonary nodules. The diagnosis of PAVM in patients remains a diagnostic challenge to the emergency physician. The most common clinical signs of PAVM are recurrent episodes of epistaxis and hemoptysis, so surgical resection is deemed the best curative option to avoid further episodes and recurrence of hemoptysis. Quite often the diagnosis is established after pathohistological examinations. We report a case of a female patient with a massive recurrent hemoptysis and without pathologic radiological findings which would suggest to PAVM and who was successfully treated with lobectomy.
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Ivan
I
Kuhajda
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Misel
M
Milosevic
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Dejan
D
Ilincic
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Danijela
D
Kuhajda
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Sandra
S
Pekovic
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Katerina
K
Tsirgogianni
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Drosos
D
Tsavlis
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Kosmas
K
Tsakiridis
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Antonios
A
Sakkas
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Angeliki
A
Kantzeli
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Konstantinos
K
Zarogoulidis
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Paul
P
Zarogoulidis
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Athanasios
A
Zissimopoulos
1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Dejan
D
Durić
Pulmonary arteriovenous malformation (PAVM); hemoptysis; surgical resection