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Abu-El-Rub H, Shatnawi R, AbuZetun YI, Ghorab D, Shotar AM. Sudden pediatric death unveiling pulmonary arteriovenous malformations. Autops Case Rep 2024; 14:e2024489. [PMID: 38803485 PMCID: PMC11129858 DOI: 10.4322/acr.2024.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/29/2024]
Abstract
Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections between pulmonary arteries and veins, often associated with hereditary hemorrhagic telangiectasia (HHT). Most PAVMs are asymptomatic, but life-threatening complications like pulmonary hemorrhage, brain abscesses, and paradoxical emboli can emerge, so prompt diagnosis and treatment are crucial. We report a case of sudden pediatric death in a two-year-old female with no past medical history. Initial vomiting and fast deterioration resulted in a sudden cardiac arrest. The postmortem examination found histological evidence of consistent, extensive lung damage. The absence of the characteristic symptoms made for some challenges when it came to diagnosis, showing precisely that in early life, you could well have many difficulties in catching PAVMs. This case highlights the need to take PAVMs into account as a potential cause of sudden death, particularly when there are no conspicuous symptoms. Awareness among forensic pathologists and consideration of genetic analysis for HHT in such cases is crucial for accurate diagnosis and management.
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Affiliation(s)
- Hadeel Abu-El-Rub
- Yarmouk University, Forensic Medicine and Toxicology Unit, Department of Clinical Sciences, Faculty of Medicine, Irbid, Jordan
| | - Rashed Shatnawi
- Yarmouk University, Forensic Medicine and Toxicology Unit, Department of Clinical Sciences, Faculty of Medicine, Irbid, Jordan
| | - Yahia I AbuZetun
- Yarmouk University, Forensic Medicine and Toxicology Unit, Department of Clinical Sciences, Faculty of Medicine, Irbid, Jordan
| | - Doaa Ghorab
- Mansoura University, Pathology Department, Faculty of Medicine, Mansoura, Egypt
| | - Ali M. Shotar
- Jordan University of Science and Technology, Department of Legal Medicine, Toxicology and Forensic Science, School of Medicine, Irbid, Jordan
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Giliberti P, De Rose DU, Landolfo F, Columbo C, Pugnaloni F, Santisi A, Conforti A, Secinaro A, Francalanci P, Bozza P, Chukhlantseva N, Savignoni F, Caforio L, Toscano A, Novelli A, Dotta A, Capolupo I, Bagolan P. Hemodynamic Assessment of a Large Pulmonary Arteriovenous Malformation in a Neonate: Case Report and Review of Literature. Pediatr Cardiol 2022; 43:1383-1391. [PMID: 35260923 DOI: 10.1007/s00246-022-02862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
Herein we report the case of a neonate with a prenatally diagnosed large pulmonary arteriovenous malformation, managed with minimally invasive hemodynamic monitoring in our Neonatal Intensive Care Unit. The combination of Near-Infrared Spectroscopy and Pressure Recording Analytical Method could guide neonatal management of critical cases of vascular anomalies: immediate data are offered to clinicians, from which therapeutic decisions such as timing of surgical resection are made to achieve a positive outcome. We also systemically collected and summarized information on patients' characteristics of previous cases reported in literature to data, and we compared them to our case.
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Affiliation(s)
- Paola Giliberti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Francesca Landolfo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy.
| | - Claudia Columbo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Andrea Conforti
- Newborn Surgery Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Paola Francalanci
- Department of Pathology, "Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Patrizia Bozza
- Department of Anesthesia and Critical Care, "Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Natalia Chukhlantseva
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Ferdinando Savignoni
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Leonardo Caforio
- Fetal Medicine and Surgery Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Laboratory, "Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
| | - Pietro Bagolan
- Newborn Surgery Unit, Medical and Surgical Department of Fetus, Newborn and Infant-"Bambino Gesù" Children's Hospital IRCCS, 00165, Rome, Italy
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Al-Ammouri I, Rabadi A, Abdel Hafez S, Al-Taher R, Bani Hani A, Samara OA, Abu Abeeleh M. Complex, Isolated Pulmonary Arteriovenous Malformation in Two Children With Severe Cyanosis. World J Pediatr Congenit Heart Surg 2021; 13:387-388. [PMID: 34825608 DOI: 10.1177/21501351211053582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present two cases of Isolated complex pulmonary arteriovenous malformations in two children presenting with cyanosis and exercise intolerance. We present the anatomical features and the management of each case. One patient was treated with surgical ligation of the draining vein, and one patient was treated percutaneously by closure of the feeding segmental artery.
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Cortes M, Mayeda GS, Liu MW. Recurrent minor strokes/TIA with a right to left shunt. BMJ Case Rep 2018; 2018:bcr-2018-224862. [PMID: 29991544 DOI: 10.1136/bcr-2018-224862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient came to our institution for evaluation and closure of suspected patent foramen ovale actively manifesting as cerebrovascular accident. Through further studies, we found the presence of a pulmonary arteriovenous fistula, which was subsequently and successfully closed through non-invasive percutaneous selective segmental pulmonary artery embolisation.
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Affiliation(s)
- Manuel Cortes
- Department of Cardiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Guy S Mayeda
- Department of Cardiology, Harbor-UCLA/Good Samaritan Hospital, Los Angeles, California, USA
| | - Ming W Liu
- Cardiology, White Memorial Medical Center, Los Angeles, California, USA
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Mohammed MHA, Hrfi A, AlQwee AM, Tamimi O. Pulmonary arteriovenous malformation in a neonate: a condition commonly misdiagnosed. Sudan J Paediatr 2018; 18:56-60. [PMID: 30799901 DOI: 10.24911/sjp.106-1528143670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary arteriovenous malformations (PAVMs) are congenital defects in the form of an anomalous bridging between a pulmonary arterial and venous system that sidesteps the normal pulmonary capillary. This anomaly is usually associated with hereditary hemorrhagic telangiectasia, leftover small group are sporadic cases but may occur as an isolated anomaly or as multiple lesions. Rarely, such abnormalities can be acquired. Few cases are diagnosed in the neonatal period, as it will pass silent without symptoms. Clinical manifestations occur soon after birth as cyanosis, tachypnea, and an abnormal sound as bruit over the AVM; and the most important point is the clinical suspicion of diagnosis in absence of pulmonary parenchymal and cardiac disease that can explain the persistence of cyanosis. We report a successful Amplatzer vascular plug occlusion of isolated multiple left side PAVM in a neonate, which was done on two stages with a 6 months interval, with no complications. Over 2-year follow-up, the patient remained well with no symptoms.
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Affiliation(s)
- Mohammed H A Mohammed
- Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,Department of Pediatrics, Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
| | - Abdah Hrfi
- Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | | | - Omar Tamimi
- Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Sharma P, Kochar P, Sharma S, Gupta N, Li S, Hooda K, Kumar Y. A case of pulmonary arteriovenous malformation: role of interventional radiology in diagnosis and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:345. [PMID: 28936439 DOI: 10.21037/atm.2017.06.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary arterio-venous malformations (PAVMs) are abnormal pulmonary arteries and pulmonary veins communicating directly without interposition of a capillary bed and about 80-90% of patients with PAVMs eventually may present with hereditary hemorrhagic telangiectasia (HHT), remaining ones are sporadic cases. On the other hand, about 15-35% of HHT patients may present with PAVMs. The PAVMs have a tendency to grow and increase in size over time and various factors like puberty, pregnancy and pulmonary arterial hypertension (PAH) affect growth. This condition needs early diagnosis, aggressive management and vigilant follow up. Our article aims to review pulmonary AVMs as a rare cause of strokes in young patients. We will discuss the clinical presentation, diagnosis, complications, the therapeutic options and the follow up.
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Affiliation(s)
- Pranav Sharma
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Puneet Kochar
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Salil Sharma
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Nishant Gupta
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Shuo Li
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
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Biswas D, Dey A, Chakraborty M, Biswas S. Pulmonary arteriovenous malformation: An uncommon disease with common presentation. Lung India 2010; 27:247-9. [PMID: 21139726 PMCID: PMC2988180 DOI: 10.4103/0970-2113.71965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old male presented with massive hemoptysis, clubbing in all limbs, disproportionate hypoxia and persistent ill-defined shadow in left lower zone in chest radiograph since his childhood. The patient received empirical anti-tuberculosis treatment and the chest X-ray finding was misinterpreted as tuberculoma. Subsequently, CT pulmonary angiography proved it to be a case of a simple type solitary pulmonary arteriovenous malformation with a saccular aneurysm in left lower lobe.
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Affiliation(s)
- Debabani Biswas
- Department of Respiratory Medicine, Calcutta National Medical College, Kolkata, India
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Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med 1998; 158:643-61. [PMID: 9700146 DOI: 10.1164/ajrccm.158.2.9711041] [Citation(s) in RCA: 383] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J R Gossage
- Section of Pulmonary Diseases, Department of Medicine, Medical College of Georgia, Augusta, Georgia, USA.
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Grady RM, Sharkey AM, Bridges ND. Transcatheter coil embolisation of a pulmonary arteriovenous malformation in a neonate. Heart 1994; 71:370-1. [PMID: 8198890 PMCID: PMC483690 DOI: 10.1136/hrt.71.4.370] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Pulmonary arteriovenous malformations (PAVM) are a rare cause of cyanosis in neonates. A large PAVM in a neonate was successfully occluded by transcatheter embolisation. At six months follow up the PAVM was undetectable and no new lesions were found. Transcatheter embolisation should be considered as the primary treatment for a PAVM in a child of any age.
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Affiliation(s)
- R M Grady
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110
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