Pulmonary arterovenous malformation causing
hemothorax in a pregnant woman without Osler-
Weber-Rendu syndrome

• Authors: Vincenzo Di Crescenzo , Filomena Napolitano , Alessandro Vatrella , Pio Zeppa , Paolo Laperuta
• Languages of publication: EN

Abstracts

EN

Pulmonary arteriovenous malformations
(PAVMs), although most commonly congenital, are
usually detected later in life. Case report: We present a
case of a 19-year-old woman with no previous history
of AVM or telangiectasia, who presented dyspnea and
hypoxia by massive left hemothorax in the 34th week of
gestation. After emergent cesarean delivery, a chest computed
tomography (CT) with i.v. contrast showed a likely
3 cm area of active contrast in left lower lung. Chest tube
placement revealed about 2 liters of blood. The patient was
subsequently found to have pulmonary AVM. A successful
embolisation of AVM followed by lung atipic resection
involving AVM and decortication for lung re-expansion
were the treatments provided. Conclusions: Women with
known pulmonary AVM should be maximally treated prior
to becoming pregnant, and the physician should be alert
to complications of pulmonary AVM during pregnancy.

Keywords

EN

Pulmonary arteriovenous malformationsOsler-Weber-Rendu syndrome pregnant woman

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2014
• Volume: 10
• Issue: 1

Dates

online

21 - 12 - 2015

received

6 - 11 - 2015

accepted

9 - 11 - 2015

Contributors

author

Vincenzo Di Crescenzo

• Department of
  Medicine and Surgery, University of Salerno, Baronissi Campus, Via
  S. Allende, 84081 Baronissi, Salerno, Italy

author

Filomena Napolitano

• Department of Medicine,
  Thoracic Surgery Unit, University of Salerno, Italy

author

Alessandro Vatrella

• Department of Medicine, Section of Respiratory
  Disease, University of Salerno, Italy

author

Pio Zeppa

• Department of Medicine and Surgery, Pathology Unit,
  University of Salerno, Italy

author

Paolo Laperuta

• Department of Medicine,
  Thoracic Surgery Unit, University of Salerno, Italy

References

• [1] Mason RJ Murray and Nadel’s textbook of respiratory medicine,Saunders, Philadelphia, ed. USA, 4th ed. 2005, 217-221
• [2] Shovlin CL, Jackson JE, Bamfordetal KB Primary determinants ofischaemic stroke and cerebral abscess are unrelated to severityof pulmonary arteriovenous malformations in HHT. Thorax2008; 63: 259-266[Crossref]
• [3] Gabbe S. G., Obstetrics: Normal and Problem Pregnancies,chapter 3, Churchill Livingstone, Philadelphia, Pa, USA, 5th ed.
• [4] Shovlin C.L., Guttmacher A.E., Buscarinietal E. Diagnosticcriteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber Syndrome) American Journal of Medical Genetics, 2000;91: 66-67[Crossref]
• [5] Govani FS, Shovlin CL Hereditary haemorrhagic telangiectasia:a clinical and scientific review. European Journal of HumanGenetics. 2009; 17, 860-871[Crossref][WoS]
• [6] Giordano P, Nigro A, Lenato GM, Guanti G, Suppressa P, LastellaP, DE Mattia D, Sabbà C. Screening for children from families with Rendu-Osler-Weber disease: from geneticist to clinician.Journal of Thrombosis and Haemostasis 2006; 4: 1237-1245[Crossref]
• [7] Shovlin CL, Sodhi V, McCarthy A, Lasjaunias P, Jackson JE,Sheppard MN Estimates of maternal risks of pregnancyfor women with hereditary haemorrhagic telangiectasia(Osler-Weber-Rendu syndrome): suggested approach forobstetric services British Journal of Obstetrics and Gynaecology2008; 115:1108-1115
• [8] Puskas JD, Allen MS, Moncure AC, Wain JC Jr, Hilgenberg AD,Wright C, Grillo HC, Mathisen DJ. Pulmonary arteriovenousmalformations: therapeutic options Annals of Thoracic Surgery,1993; 56: 253-258[Crossref]
• [9] Laperuta P, Napolitano F, Vatrella A, Di Crescenzo RM, CorteseA, Di Crescenzo V. Post-pneumonectomy broncho-pleural fistulasuccessfully closed by open-window thoracostomy associatedwith V.A.C. therapy. Int J Surg. 2014;12 Suppl 2:S17-9[WoS][Crossref]
• [10] Fiorelli A, Vicidomini G, Mazzella A, Messina G, Milione R, DiCrescenzo VG, Santini M. The influence of body mass index andweight loss on outcome of elderly patients undergoing lungcancer resection. Thorac Cardiovasc Surg. 2014; 62:578-587[WoS][Crossref]
• [11] Guerra A, Carrano M, Angrisani E, Puzziello A, Izzo G, DiCrescenzo V, Vatrella A, Vitale M. Detection of RAS mutation bypyrosequencing in thyroid cytology samples. Int J Surg. 2014;12 Suppl 1:91-94[Crossref][WoS]
• [12] Laperuta P, Napolitano F, Garzi A, Amato B, Vatrella A, DiCrescenzo V. Extrathoracic recurrence of type A thymoma. Int JSurg. 2014;12 Suppl 1:S16-8[Crossref]
• [13] Di Crescenzo V, Laperuta P, Garzi A, Napolitano F, CasconeA, Vatrella A. Small cell lung cancer associated with solitaryfibrous tumors of the pleura: a case study and literature review.Int J Surg. 2014;12 Suppl 1:S19-21[WoS]
• [14] Fiorelli A, Petrillo M, Vicidomini G, Di Crescenzo VG, FrongilloE, De Felice A, Rotondo A, Santini M. Quantitative assessmentof emphysematous parenchyma using multidetector-rowcomputed tomography in patients scheduled for endobronchialtreatment with one-way valves. Interact Cardiovasc ThoracSurg. 2014;19:246-255
• [15] Fiorelli A, Mazzone S, Di Crescenzo V, Vicidomini G, CostanzaS, Del Prete A, Mazzone A, Santini M. A simple techniqueto facilitate Dumon silicone stent placement in subglotticaltracheal stenosis. Interact Cardiovasc Thorac Surg. 2014Mar;18(3):390-392
• [16] Guerra A, Di Crescenzo V, Garzi A, Cinelli M, Carlomagno C,Pepe S, Zeppa P, Tonacchera M, Vitale M. Diagnostic utilityof BRAFV600E mutation testing in thyroid nodules in elderlypatients. BMC Surg. 2013;13 Suppl 2:S37. doi: 10.1186/1471-2482-13-S2-S37. Epub 2013 Oct 8.[Crossref]
• [17] Di Crescenzo V., Laperuta P., Napolitano F., Carlomagno C.,Garzi A., Vitale M. Pulmonary sequestration presented asmassive left hemothorax and associated with primary lungsarcoma. BMC Surg. 2013;13 Suppl 2:S34[WoS]
• [18] Di Crescenzo V., Laperuta P., Napolitano F., Carlomagno C.,Garzi A., Vitale M. An unusual case of primary choriocarcinomaof the lung. BMC Surg. 2013;13 Suppl 2:S33[Crossref][WoS]
• [19] Di Crescenzo V, Laperuta P, Napolitano F, Carlomagno C, DanziM, Amato B, Garzi A, Vitale M. Migration of surgical clipsthrough a right lobectomy stump mimicking an asthmaticsyndrome. BMC Surg. 2013;13 Suppl 2:S32[WoS][Crossref]
• [20] Di Crescenzo V, Laperuta P, Napolitano F, Carlomagno C, DanziM, Amato B, Garzi A, Vitale M. Unusual case of exacerbationof sub-acute descending necrotizing mediastinitis. BMC Surg.2013;13 Suppl 2:S31[Crossref][WoS]
• [21] Caleo A, Vigliar E, Vitale M, Di Crescenzo V, Cinelli M,Carlomagno C, Garzi A, Zeppa P. Cytological diagnosis ofthyroid nodules in Hashimoto thyroiditis in elderly patients.BMC Surg. 2013;13 Suppl 2:S41. doi: 10.1186/1471-2482-13-S2-S41. Epub 2013 Oct 8[WoS][Crossref]
• [22] Guerra A, Di Crescenzo V, Garzi A, Cinelli M, Carlomagno C,Tonacchera M, Zeppa P, Vitale M. Genetic mutations in thetreatment of anaplastic thyroid cancer: a systematic review.BMC Surg. 2013;13 Suppl 2:S44. doi: 10.1186/1471-2482-13-S2-S44. Epub 2013 Oct 8. Review[Crossref]
• [23] Di Crescenzo V, Garzi A, Petruzziello F, Cinelli M, Catalano L,Zeppa P, Vitale M. Nodular goiter with amyloid deposition in anelderly patient: fine-needle cytology diagnosis and review ofthe literature. BMC Surgery 2013;13:S43[WoS]
• [24] Fiorelli A., Morgillo F., Fasano M., Vicidomini G., Di CrescenzoV.G., Di Domenico M., Accardo M, Santini M.. The value ofmatrix metalloproteinase 9 and vascular endothelial growthfactor receptor 1 pathway in diagnosing indeterminate pleural.Interact Cardiovasc Thorac Surg. 2013; 16:263-269
• [25] Santini M, Fiorello A, Di Lieto E, Di Crescenzo VG, D’AnielloG, Vicidomini G, Perrone A, Pastore V. Surgical strategies incervico-mediastinal goiters. Minerva Chir. 2006; 6: 221-229
• [26] Baldi C, Ieni A, Cozzolino I, Cerbone V, Memoli D, Zeppa P.Ultrasound-guided fine needle aspiration cytology of a primarylymph node leiomyoma: a flexible procedure for a complexcase. Acta Cytol. 2014;58:303-308[Crossref]
• [27] Cozzolino I, Vigliar E, Todaro P, Peluso AL, Picardi M, SosaFernandez LV, Mignogna MD, Tuccari G, Selleri C, Zeppa P. Fineneedle aspiration cytology of lymphoproliferative lesions of theoral cavity. Cytopathol. 2014;25:241-249[Crossref]
• [28] Vigliar E, Cozzolino I, Picardi M, Peluso AL, Fernandez LV,Vetrani A, Botti G, Pane F, Selleri C, Zeppa P. Lymph node fineneedle cytology in the staging and follow-up of cutaneouslymphomas. BMC Cancer. 2014;14:8[WoS][Crossref]
• [29] Zeppa P, Barra E, Napolitano V, Cozzolino I, Troncone G,Picardi M, De Renzo, A, Mainenti PP, Vetrani A, PalombiniL. Impact of endoscopic ultrasound-guided fine needleaspiration (EUS-FNA) in lymph nodal and mediastinal lesions: amulticenter experience. Diagn Cytopathol. 2011;39:723-729[Crossref][WoS]
• [30] Cozzolino I, Nappa S, Picardi M, De Renzo A, Troncone G,Palombini L, Zeppa P. Clonal B-cell population in a reactivelymph node in acquired immunodeficiency syndrome. DiagnCytopathol. 2009;37:910-914[WoS][Crossref]
• [31] Zeppa P, Vitale M. Fine-needle cytology of Hürthle cell tumorsand morphometry. Cancer Cytopathol. 2014;122:553[Crossref]
• [32] Zeppa P, Sosa Fernandez LV, Cozzolino I, Ronga V, GenesioR, Salatiello M, Picardi M, Malapelle U, Troncone G, VigliarE. Immunoglobulin heavy-chain fluorescence in situhybridization-chromogenic in situ hybridization DNA probesplit signal in the clonality assessment of lymphoproliferativeprocesses on cytological samples. Cancer Cytopathol.2012;120:390-400[Crossref][WoS]
• [33] Vigliar E, Cozzolino I, Fernandez LV, Di Pietto L, Riccardi A,Picardi M, Pane F, Vetrani A, Troncone G, Zeppa P. Fine-needlecytology and flow cytometry assessment of reactive andlymphoproliferative processes of the breast. Acta Cytol.2012;56:130-138[WoS][Crossref]
• [34] Sorrentino R, Terlizzi M, Di Crescenzo VG, Popolo A, PecoraroM, Perillo G, Galderisi A, Pinto A. Human Lung Cancer-DerivedImmunosuppressive Plasmacytoid Dendritic Cells Release IL-1αin an AIM2 Inflammasome-Dependent Manner. Am J Pathol.2015 Nov;185(11):3115-3124
• [35] Esposito S, Gioia R, De Simone G, Noviello S, Lombardi D, DiCrescenzo VG, Filippelli A, Rega MR, Massari A, Elberti MG,Grisi L, Boccia G, De Caro F, Leone S. Bacterial Epidemiologyand Antimicrobial Resistance in the Surgery Wards of a LargeTeaching Hospital in Southern Italy. Mediterr J Hematol InfectDis. 2015 Jun 1;7(1)
• [36] Terlizzi M, Di Crescenzo VG, Perillo G, Galderisi A, PintoA, Sorrentino R. Pharmacological inhibition of caspase-8limits lung tumour outgrowth. Br J Pharmacol. 2015Aug;172(15):3917-3928
• [37] Vatrella A, Galderisi A, Nicoletta C, Maglio A, Cortese A, DiCrescenzo RM, Ieni A, Crisci A, Di Crescenzo V. Age as a riskfactor in the occurrence of pneumothorax after transthoracicfine needle biopsy: our experience. Int J Surg.2014;12 Suppl2:S29-32[WoS]

Identifiers

DOI

10.1515/med-2015-0093