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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Background: Mesenchymal dysplasias or inherited connective tissue diseases are the group of diseases with deficiency of various components of connective tissue. Connective tissue disorders can affect different organs: skeleton, sight organ, skin, lungs, heart. But the most dangerous is vascular wall insufficiency leading to high risk of hemorrhage, especially during pregnancy and delivery due to hemodynamic and hormonal effects on the walls of the modified vessels.Aim: To evaluate the risk of complications during the pregnancy and delivery in patients with mesenchymal dysplasias.Study design: Fifty-six pregnancies in patients with mesenchymal dysplasias, including subclinical forms of diseases: 23 with Marfan syndrome (I group), 22 with Ehlers-Danlos syndrome (II group), and 11 with Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia) (III group) of the age from 18 to 36. The study included retrospective analysis (for the period from 1993 to 2005) and prospective study. Results of study showed high risk of life-threatening complications during pregnancy and delivery, especially the risk of hemorrhage and cardiovascular complications. In all the patients, we observed the progression of bleeding or development of bleeding in new localizations (epistaxis in 27 patients, easy brushing in 22, skin and mucosa telangiectasia in 20, gastrointestinal bleedings in 4, hemoptysis in 4, hematomas for minor traumas in 14, conjunctivas hemorrhages in 5).Conclusion: The pathogenesis of bleeding in such patients has mixed pattern: besides vascular wall pathology coagulation deficiency plays some role. The preferred delivery method for such patients is caesarean section. Deep vaginal ruptures and serious hemorrhage accompany vaginal delivery.
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PMID:Prenatal care and labor in patients with mesenchimal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia). 2993 56

Pulmonary arteriovenous malformations (PAVMs) are rare, abnormal low resistance vascular structures that connect a pulmonary artery to a pulmonary vein, thereby bypassing the normal pulmonary capillary bed and resulting in an intrapulmonary right-to-left shunt. The spectrum of PAVMs extends from microscopic lesions causing profound hypoxemia and ground glass appearance on computed tomography (CT) but with normal catheter angiographic findings to classic pulmonary aneurysmal connections that abnormally connect pulmonary veins and arteries. These malformations most commonly are seen in hereditary hemorrhagic telangiectasia (HHT). They are rarely due to secondary conditions such as post congenital heart disease surgery or hepatopulmonary syndrome (HPS). The main complications of PAVM result from intrapulmonary shunt and include stroke, brain abscess, and hypoxemia. Local pulmonary complications include PAVM rupture leading to life-threatening hemoptysis or hemothorax. The preferred screening test for PAVM is transthoracic contrast echocardiography (TTCE). CT has become the gold standard imaging test to establish the presence of PAVM. Endovascular occlusion of the feeding artery is the treatment of choice. Collateralization and recanalization of PAVM following treatment may occur, and hence long term clinical and imaging follow-up is required to assess PAVM enlargement and PAVM reperfusion.
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PMID:Pulmonary arteriovenous malformations: diagnosis. 3005 79

Pulmonary arteriovenous malformations (PAVMs) comprise an anomalous communication between the pulmonary arterial and systemic circulation. The drainage is usually into one of the pulmonary veins, although rare instances of direct drainage into the left atrium or inferior vena cava have been reported. The result is a high-flow, low-resistance, right-toleft shunt. Although considered uncommon, PAVMs are being diagnosed with increasing frequency in this era of enhanced cross-sectional imaging with CT for lung screening. There is a strong association between PAVMs and hereditary haemorrhagic telangiectasia (HHT); PAVMs are more commonly found in females, with a female to male ratio of 8:1. These have varying clinical presentation, with most symptomatic PAVMs being diagnosed in the first three decades of life. The most common mode of presentation is dyspnoea on exertion. Other reported symptoms are epistaxis, chest pain, cough and, in the event of rupture, haemoptysis. Endocarditis, stroke and brain abscess formation occur frequently in patients with undiagnosed HHT with PAVMs. A 76-year-old female, with a presumed clinical diagnosis of asthma, presented to the emergency department with worsening shortness of breath. The imaging studies revealed a giant PAVM and a radionuclide scan demonstrated a large right-to-left shunt, likely accounting for her symptoms. She underwent successful transcatheter embolization (TCE) with a vascular plug performed by the interventional radiology team. The aim of this case report is to describe the imaging findings and TCE treatment of a giant PAVM.
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PMID:Imaging features and transcatheter treatment of a giant pulmonary arteriovenous malformation in an elderly patient. 3036 86

Pulmonary arteriovenous malformations (PAVMs) or fistulas are rare direct pathological connections between pulmonary arterial and venous circulation. Most of PAVMs are congenital and closely associated with hereditary hemorrhagic telangiectasia, but acquired PAVMs have also been described in the literature. Diagnosis of PAVMs is a priority for clinicians, in order to prevent potentially fatal events such as cerebrovascular stroke, systemic septic embolization, hemoptysis and hemothorax. In this scenario, the radiologist plays a key role in both diagnostic and therapeutic workups of PAVMs: Chest X-ray, computed tomography and magnetic resonance are effective tools for PAVMs identification and confirmation of the suspected diagnosis. Furthermore, imaging modalities provide most of the elements for PAVMs classification according to their angioarchitecture (simple and complex) and help the clinicians in establishing which lesion requires prompt treatment and which one will benefit of imaging follow-up alone. Endovascular management of PAVMs has grown up as the first-line treatment in respect of surgery during last decades, showing lower risk of intra- and post-procedural complications and offering a wide number of treatment options and materials, ensuring effective management in virtually any clinical situation; interventional treatment aims to exclude PAVMs from pulmonary circulation, and specific technique and embolic agents should be selected according to pre-treatment imaging, in order to obtain the best procedural outcome. This paper proposes a review of the clinical and radiological features that a radiologist needs to know for PAVMs diagnosis and proper management, also showing an overview of the most common endovascular treatment strategies and embolization materials.
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PMID:Pulmonary arteriovenous malformations: what the interventional radiologist needs to know. 3120 90

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary artery and vein through a thin-walled aneurysmal sac, leading to a right-to-left shunt. These are commonly associated with hereditary hemorrhagic telangiectasia, and treatment guidelines have been set on how to approach their management. Incorrect proximal placement of an embolization device can lead to delayed recruitment of systemic collaterals leading to presentation with hemoptysis. We are presenting a case of a 17-year-old male with treated PAVMs and with fresh hemoptysis. In this case report, we attempt to explain the management of such a complication and follow the principles of arteriovenous malformation embolization on the left side.
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PMID:Endovascular Management of Massive Hemoptysis Secondary to Systemic Collaterals in Previously Treated Pulmonary Arteriovenous Malformation. 3143 Nov 48

Pulmonary Arteriovenous Fistula (PAVF) is an abnormal communication between the pulmonary veins and pulmonary arteries. Most individuals may have the condition since birth (congenital occurrence), but it can also be an acquired condition. Most individuals with Pulmonary Arteriovenous Fistula also have a hereditary haemorrhagic telangiectasia. The common signs and symptoms of Pulmonary Arteriovenous Fistula are shortness of breath, haemoptysis, chest pain, dizziness, and syncope. Pulmonary Arteriovenous Fistula is treated with embolization and surgery. PAVF are more common in females than males. Complete evaluation of medical history along with a thorough physical examination required to diagnose PAVF. The CT scan is more sensitive than a chest x-ray in establishing a diagnosis. However pulmonary angiography is the gold standard. Many clinical conditions may have similar signs and symptoms. PAVF is associated with variety of complications, some of which may be life-threatening. These may include: Stroke, bleeding in the lung and brain abscess. Typically, individuals with mild conditions presenting no symptoms may not require any treatment. The treatment of Pulmonary Arteriovenous Fistula may include: Embolization and surgery (the later may be required in a cases not responding to embolization). During surgery, the abnormal vessels are removed along with surrounding lung tissue. We report a rare case of large right pulmonary arterio-venous fistula (PAVF) which was misdiagnosed as mass lung in a 30-year-old lady who presented with generalized seizures due to secondary polycythemia, right sided hemiparesis, central cyanosis and clubbing. She had hypoxemia while breathing ambient air and little improvement with 100% oxygen. Diagnosis was clinched by pulmonary CT angiography which revealed a large PAVF.
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PMID:An unusual case of pulmonary arterio-venous fistula (PAVF). 3174 78

A 25-year-old gravida 3 para 3 with a history of hereditary haemorrhagic telangiectasia (HHT) and embolised pulmonary arteriovenous malformations (PAVMs) was admitted at 36 weeks gestation with haemoptysis, epistaxis and CT evidence of recent alveolar haemorrhage. An urgent caesarean section was planned. Both previous pregnancies had been delivered by elective lower segment caesarean section (LSCS) under subarachnoid block (SAB) at term. Preanaesthetic planning involved consultation with our tertiary maternity referral centre, the national HHT centre and our tertiary adult referral centre, which has interventional radiology and cardiothoracic capabilities. A whole spine MRI was carried out to rule out vascular malformation. Following multidisciplinary discussion, the decision was made to proceed with caesarean section in our hospital under SAB. Wide bore intravenous access was sited and blood product availability was ensured in case of acute pulmonary haemorrhage. The LSCS was uneventful. Postoperatively following discharge from the hospital, the patient experienced recurrent episodes of small volume haemoptysis, and had further PAVM embolisation in the national HHT centre. This report highlights the difficulties in managing complex parturients in a non-tertiary referral centre and underlines the importance of communication and multidisciplinary team discussion to determine the most appropriate management.
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PMID:Anaesthetic management of a parturient with hereditary haemorrhagic telangiectasia (HHT) and pulmonary haemorrhage requiring urgent caesarean section. 3193 26

Hemoptysis is one of the most common reasons for seeking emergency care. Infections and malignancy are the leading causes of hemoptysis although caused by various other pulmonary and extrapulmonary conditions. Most causes are self-limiting and do not warrant any aggressive investigation. Endobronchial telangiectasia can rarely cause hemoptysis and is seen in patients with hemorrhagic hereditary telangiectasia or scleroderma. Isolated diffuse endobronchial telangiectasia is rare and is only reported in one case in literature. We present another case of diffuse endobronchial telangiectasia in a young adult who presented with recurrent hemoptysis. Computer tomography scan was normal, but bronchoscopy showed multiple endobronchial arteriovenous malformations in the entire tracheobronchial tree.
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PMID:Diffuse Endobronchial Telangiectasia. 3256 32

Ischemic stroke involving multiple artery territory with normal vessels gives a clue for an embolic stroke. Paradoxical embolization is a recognized cause of ischemic stroke. We describe a 48-year-old male who presented with acute onset giddiness, mild dysarthria, right hemiparesis, and ataxia. Clinical examinations indicated left cerebellar signs with right hemiparesis. Additionally, the patient had significant clubbing and mild cyanosis. A strong family history of epistaxis and hemoptysis was noted. His Magnetic resonance imaging of the brain showed acute left cerebellar and left frontal cortical infarct with normal vessels. The routine stroke and cardiac workup were normal. Chest X-ray showed bilateral lower zone opacities. Contrast-enhanced computerized tomogram (CT) of the chest showed bilateral pulmonary arteriovenous malformation. Paradoxical embolism due to pulmonary arteriovenous malformation resulted in ischemic stroke in our patient. He fulfilled all of the four criteria for diagnosing definite hereditary hemorrhagic telangiectasia. Our case highlights the importance of a systematic search for paradoxical embolism in a cryptogenic stroke.
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PMID:Paradoxical Embolism in a Case of Hereditary Hemorrhagic Telangiectasia: Case Report with Literature Review. 3264 84

Pulmonary arteriovenous malformations (PAVMs) are rare vascular structures providing direct capillary-free communications between pulmonary arteries and veins. Embolotherapy is indicated as a front-line therapy. We report an unusual long-term complication of coil embolization for a 44-year-old woman with hereditary hemorrhagic telangiectasia (HHT) who had repeatedly undergone the procedures for her PAVMs. She expectorated the coil which had been placed 12 years earlier and migrated to the bronchus according to the chest radiogram and bronchoscopy. Histology of the resected lung segment suggested the cavity communicating with the bronchus was the consequence of abscess formation around the coils. Even after technically successful embolization to PAVMs, long term follow-up should be necessary paying attention to the symptoms and imaging to avoid massive hemoptysis and subsequent emergency surgery.
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PMID:Migrated coil expectorated 12 years after embolization of pulmonary arteriovenous malformation, due probably to abscess formation around the coil. 3308 22


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