A case of transcatheter coil embolization for pulmonary arteriovenous malformation complicated with hepatic arteriovenous malformation
A 57-year-old woman in whom pulmonary arteriovenous malformation (PAVM) associated with hereditary hemorrhagic telangiectasia (HHT) had been diagnosed after a chest X-ray film showed an abnormal shadow at the age of 39. After diagnosis, she suffered two ischemic brain attacks, presumably caused by PAVM. She was admitted to our hospital for evaluation and treatment of PAVM on February 9, 2008. We confirmed two PAVMs in right S(3)a and left S(9)a by chest CT scan and angiography. In addition, abdominal CT revealed hepatic arteriovenous malformation (HAVM). HAVM were thought to increase venous return to the right heart, (which might cause pulmonary hypertension after the embolization of PAVMs), leading to right heart failure. In order to prevent neurological events in future, we performed an embolization of PAVM with individual coils at monthly intervals. Six months after the last embolization treatment, she showed no symptoms of right heart failure and the size of PAVMs decreased. It is considered important for a patient with PAVM associated with HHT to undergo a thorough examination for arteriovenous malformation in other organs, before coil embolization.