Congenital systemic-to-pulmonary arteriovenous fistula: report of a case

Systemic-pulmonary arteriovenous fistulae with pulmonary hypertension: A case report

BACKGROUND

Arteriovenous (AV) fistulae is an extremely rare disease of vascular malformation that involves fistulae formation between the systemic and pulmonary AV systems.

CASE REPRESENTATION

This case report describes a rare systemic-pulmonary AV fistulae of congenital origin, accompanied by pulmonary hypertension, as determined by aortic angiography and echocardiography.

CONCLUSION

Characteristics, diagnosis, and therapeutic approaches of this rare abnormality are explored.

Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: closure with vascular plugs & coil embolization

A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as¹ anomalous supply by normal systemic artery [internal mammary artery]² and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.

Radionuclide angiography and ventilation/perfusion studies in two patients with systemic arterial supply to the basal segment of the left lung

The findings of radionuclide studies in two adult men with systemic arterial supply to the basal segment of the left lung without sequestration are reported. Radionuclide angiography with Tc-99m human serum albumin-diethylenetriamine showed that the lung was perfused by the systemic circulation rather than by the pulmonary artery. Ventilation and perfusion scans with Xe-133 and Tc-99m MAA showed a V/Q mismatch in this area, suggesting the presence of normal bronchial communication without a pulmonary arterial supply. These results also suggest the presence of a left-to-left shunt in the well-ventilated lung in this area. MRI and conventional angiography showed an aberrant artery arising from the descending thoracic aorta, supplying the basal segment of the left lung without a pulmonary artery. In both patients, left lower lobectomy showed normal alveobronchial structures without sequestration. Radionuclide angiography and ventilation/perfusion imaging appear to be reliable noninvasive methods for diagnosing this rare anomaly with a left-to-left shunt.

Aberrant systemic arterial supply to the left lung with congestive heart failure

A six-month-old girl with an aberrant systemic arterial supply from the descending thoracic aorta to the left lower lobe had congestive heart failure. Although the pulmonary parenchyma was normal, there was an absence of normal pulmonary arterial supply to the left lower lobe. Main pulmonary arterial and aortic cineangiograms led to the correct diagnosis. Left lower lobectomy was performed and resulted in clinical and hemodynamic improvement.

Anomalous systemic arterial supply to the basal segments of the lung presenting with a murmur

A murmur was discovered on routine preschool physical examination of a 5 year and 7 month-old boy. A lower lobe lesion was detected by chest X-ray. Aortography demonstrated that a large systemic artery from the descending thoracic aorta supplied the basilar segments of the left lower lobe, which had no normal pulmonary arterial supply. A clinical diagnosis of intralobar sequestration of the lung was made, and left lower lobectomy was performed.

Systemic artery-to-pulmonary vein fistula in osteogenic sarcoma of the chest wall

An arteriovenous fistula between the systemic and pulmonary circulations may be congenital, as in bronchopulmonary sequestration, or the communication may be acquired. Inflammatory disease, trauma, and, rarely, neoplasm have been implicated as possible causes of acquired communications. We describe a patient who had a systemic artery-to-pulmonary vein fistula that was secondary to a recurrent sarcoma of the chest wall. Review of the literature failed to reveal a previous report of a similar case.

Congenital fistula between an aberrant systemic artery and a pulmonary vein without sequestration. A report of three cases

Three children had an arteriovenous fistula between an aberrant vessel from the descending aorta and a normal pulmonary vein in the posterior basal segment of a lung. The affected lung was otherwise normally developed. Only a few similar cases could be found in the literature.

Pulmonary arteriovenous fistula. A review

A successfully treated case of an arteriovenous fistula of the lung is reported. An exhaustive review is made of the pertinent literature and the pathophysiology, embryology, clinical aspects, diagnosis and treatment are discussed.