Skip to main content
Top
Published in: The International Journal of Cardiovascular Imaging 8/2019

01-08-2019 | Review paper

Pulmonary arteriovenous malformations

Authors: Sreeshma Tellapuri, Harold S. Park, Sanjeeva P. Kalva

Published in: The International Journal of Cardiovascular Imaging | Issue 8/2019

Login to get access

Abstract

Pulmonary arteriovenous malformation, a condition most commonly associated with hereditary hemorrhagic telangiectasia, is an abnormal communication between the pulmonary artery and pulmonary vein without an intervening capillary communication. Although asymptomatic in ~ 50% individuals, it can present with the dreaded complications of stroke or intracranial abscess in high-risk individuals including pregnant women, if untreated. The mainstay of treatment is now endovascular embolization of the feeding artery which can alleviate the symptoms and prevent these complications. In this review, we describe the pathophysiology, methods of screening, diagnostic workup and treatment of these vascular lesions with a particular focus on the currently used embolization techniques and their outcomes.
Literature
1.
go back to reference Churton T (1896) Multiple aneurysms of pulmonary artery. Br Med J 1897(v.1):1223 Churton T (1896) Multiple aneurysms of pulmonary artery. Br Med J 1897(v.1):1223
4.
go back to reference Moussouttas M, Fayad P, Rosenblatt M, Hashimoto M, Pollak J, Henderson K, Ma TYZ, White RI (2000) Pulmonary arteriovenous malformations. Neurology 55(7):959CrossRef Moussouttas M, Fayad P, Rosenblatt M, Hashimoto M, Pollak J, Henderson K, Ma TYZ, White RI (2000) Pulmonary arteriovenous malformations. Neurology 55(7):959CrossRef
5.
go back to reference Goodenberger DM, Chakinala M (2015) Pulmonary arteriovenous malformations. In: Grippi MA, Elias JA, Fishman JA et al (eds) Fishman’s pulmonary diseases and disorders, 5th ed. McGraw-Hill Education, New York Goodenberger DM, Chakinala M (2015) Pulmonary arteriovenous malformations. In: Grippi MA, Elias JA, Fishman JA et al (eds) Fishman’s pulmonary diseases and disorders, 5th ed. McGraw-Hill Education, New York
7.
go back to reference Shovlin CL, Letarte M (1999) Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax 54(8):714–729CrossRef Shovlin CL, Letarte M (1999) Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax 54(8):714–729CrossRef
8.
go back to reference Haitjema T, Westermann CJ, Overtoom TT, Timmer R, Disch F, Mauser H, Lammers JW (1996) Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease): new insights in pathogenesis, complications, and treatment. Arch Intern Med 156(7):714–719CrossRef Haitjema T, Westermann CJ, Overtoom TT, Timmer R, Disch F, Mauser H, Lammers JW (1996) Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease): new insights in pathogenesis, complications, and treatment. Arch Intern Med 156(7):714–719CrossRef
14.
go back to reference Nakayama M, Nawa T, Chonan T, Endo K, Morikawa S, Bando M, Wada Y, Shioya T, Sugiyama Y, Fukai S (2012) Prevalence of pulmonary arteriovenous malformations as estimated by low-dose thoracic CT screening. Intern Med 51(13):1677–1681CrossRef Nakayama M, Nawa T, Chonan T, Endo K, Morikawa S, Bando M, Wada Y, Shioya T, Sugiyama Y, Fukai S (2012) Prevalence of pulmonary arteriovenous malformations as estimated by low-dose thoracic CT screening. Intern Med 51(13):1677–1681CrossRef
16.
go back to reference Swinburne AJ, Fedullo AJ, Gangemi R, Mijangos JA (1986) Hereditary telangiectasia and multiple pulmonary arteriovenous fistulas. Clinical deterioration during pregnancy. Chest 89(3):459–460CrossRef Swinburne AJ, Fedullo AJ, Gangemi R, Mijangos JA (1986) Hereditary telangiectasia and multiple pulmonary arteriovenous fistulas. Clinical deterioration during pregnancy. Chest 89(3):459–460CrossRef
19.
go back to reference McAllister KA, Grogg KM, Johnson DW, Gallione CJ, Baldwin MA, Jackson CE, Helmbold EA, Markel DS, McKinnon WC, Murrell J et al (1994) Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet 8(4):345–351. https://doi.org/10.1038/ng1294-345 CrossRef McAllister KA, Grogg KM, Johnson DW, Gallione CJ, Baldwin MA, Jackson CE, Helmbold EA, Markel DS, McKinnon WC, Murrell J et al (1994) Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet 8(4):345–351. https://​doi.​org/​10.​1038/​ng1294-345 CrossRef
23.
go back to reference Faughnan ME, Lui YW, Wirth JA, Pugash RA, Redelmeier DA, Hyland RH, White RI Jr (2000) Diffuse pulmonary arteriovenous malformations: characteristics and prognosis. Chest 117(1):31–38CrossRef Faughnan ME, Lui YW, Wirth JA, Pugash RA, Redelmeier DA, Hyland RH, White RI Jr (2000) Diffuse pulmonary arteriovenous malformations: characteristics and prognosis. Chest 117(1):31–38CrossRef
25.
go back to reference Dines DE, Arms RA, Bernatz PE, Gomes MR (1974) Pulmonary arteriovenous fistulas. Mayo Clin Proc 49(7):460–465PubMed Dines DE, Arms RA, Bernatz PE, Gomes MR (1974) Pulmonary arteriovenous fistulas. Mayo Clin Proc 49(7):460–465PubMed
27.
go back to reference Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, Spears J, Brown DH, Buscarini E, Chesnutt MS, Cottin V, Ganguly A, Gossage JR, Guttmacher AE, Hyland RH, Kennedy SJ, Korzenik J, Mager JJ, Ozanne AP, Piccirillo JF, Picus D, Plauchu H, Porteous ME, Pyeritz RE, Ross DA, Sabba C, Swanson K, Terry P, Wallace MC, Westermann CJ, White RI, Young LH, Zarrabeitia R (2011) International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 48(2):73–87. https://doi.org/10.1136/jmg.2009.069013 CrossRefPubMed Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, Spears J, Brown DH, Buscarini E, Chesnutt MS, Cottin V, Ganguly A, Gossage JR, Guttmacher AE, Hyland RH, Kennedy SJ, Korzenik J, Mager JJ, Ozanne AP, Piccirillo JF, Picus D, Plauchu H, Porteous ME, Pyeritz RE, Ross DA, Sabba C, Swanson K, Terry P, Wallace MC, Westermann CJ, White RI, Young LH, Zarrabeitia R (2011) International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 48(2):73–87. https://​doi.​org/​10.​1136/​jmg.​2009.​069013 CrossRefPubMed
29.
go back to reference Aller R, Moya JL, Moreira V, Boixeda D, Cano A, Picher J, Garcia-Rull S, de Luis DA (1999) Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography. Dig Dis Sci 44(6):1243–1248CrossRef Aller R, Moya JL, Moreira V, Boixeda D, Cano A, Picher J, Garcia-Rull S, de Luis DA (1999) Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography. Dig Dis Sci 44(6):1243–1248CrossRef
32.
go back to reference Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJ, Kjeldsen AD, Plauchu H (2000) Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 91(1):66–67CrossRef Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJ, Kjeldsen AD, Plauchu H (2000) Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 91(1):66–67CrossRef
35.
go back to reference Gazzaniga P, Buscarini E, Leandro G, Reduzzi L, Grosso M, Pongiglione G, Pedrinazzi C, Lanzarini L, Portugalli V, Blotta P, Forner P, Boccardi E, Pagella F, Manfredi G, Olivieri C, Zambelli A, Danesino C, Inama G (2009) Contrast echocardiography for pulmonary arteriovenous malformations screening: does any bubble matter? Eur J Echocardiogr 10(4):513–518. https://doi.org/10.1093/ejechocard/jen317 CrossRefPubMed Gazzaniga P, Buscarini E, Leandro G, Reduzzi L, Grosso M, Pongiglione G, Pedrinazzi C, Lanzarini L, Portugalli V, Blotta P, Forner P, Boccardi E, Pagella F, Manfredi G, Olivieri C, Zambelli A, Danesino C, Inama G (2009) Contrast echocardiography for pulmonary arteriovenous malformations screening: does any bubble matter? Eur J Echocardiogr 10(4):513–518. https://​doi.​org/​10.​1093/​ejechocard/​jen317 CrossRefPubMed
36.
go back to reference Hofmann LV, Kuszyk BS, Mitchell SE, Horton KM, Fishman EK (2000) Angioarchitecture of pulmonary arteriovenous malformations: characterization using volume-rendered 3-D CT angiography. Cardiovasc Intervent Radiol 23(2):165–170CrossRef Hofmann LV, Kuszyk BS, Mitchell SE, Horton KM, Fishman EK (2000) Angioarchitecture of pulmonary arteriovenous malformations: characterization using volume-rendered 3-D CT angiography. Cardiovasc Intervent Radiol 23(2):165–170CrossRef
39.
go back to reference Ohno Y, Hatabu H, Takenaka D, Adachi S, Hirota S, Sugimura K (2002) Contrast-enhanced MR perfusion imaging and MR angiography: utility for management of pulmonary arteriovenous malformations for embolotherapy. Eur J Radiol 41(2):136–146CrossRef Ohno Y, Hatabu H, Takenaka D, Adachi S, Hirota S, Sugimura K (2002) Contrast-enhanced MR perfusion imaging and MR angiography: utility for management of pulmonary arteriovenous malformations for embolotherapy. Eur J Radiol 41(2):136–146CrossRef
42.
go back to reference Taylor BG, Cockerill EM, Manfredi F, Klatte EC (1978) Therapeutic embolization of the pulmonary artery in pulmonary arteriovenous fistula. Am J Med 64(2):360–365CrossRef Taylor BG, Cockerill EM, Manfredi F, Klatte EC (1978) Therapeutic embolization of the pulmonary artery in pulmonary arteriovenous fistula. Am J Med 64(2):360–365CrossRef
48.
go back to reference Lee DW, White RI Jr, Egglin TK, Pollak JS, Fayad PB, Wirth JA, Rosenblatt MM, Dickey KW, Burdge CM (1997) Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg 64(4):930–939 (discussion 939-940)CrossRef Lee DW, White RI Jr, Egglin TK, Pollak JS, Fayad PB, Wirth JA, Rosenblatt MM, Dickey KW, Burdge CM (1997) Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg 64(4):930–939 (discussion 939-940)CrossRef
49.
go back to reference Chamarthy MR, Park H, Sutphin P, Kumar G, Lamus D, Saboo S, Anderson M, Kalva SP (2018) Pulmonary arteriovenous malformations: endovascular therapy. Cardiovasc Diagn Therapy 8(3):338–349 Chamarthy MR, Park H, Sutphin P, Kumar G, Lamus D, Saboo S, Anderson M, Kalva SP (2018) Pulmonary arteriovenous malformations: endovascular therapy. Cardiovasc Diagn Therapy 8(3):338–349
51.
Metadata
Title
Pulmonary arteriovenous malformations
Authors
Sreeshma Tellapuri
Harold S. Park
Sanjeeva P. Kalva
Publication date
01-08-2019
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 8/2019
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-018-1479-x

Other articles of this Issue 8/2019

The International Journal of Cardiovascular Imaging 8/2019 Go to the issue