eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
SCImago Journal & Country Rank
2/2015
vol. 11
 
Share:
Share:
more
 
 

Letter to the Editor
Pulmonary arteriovenous malformation mimicking a pulmonary tumour on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography

Umut Elboga
,
Ebuzer Kalender
,
Y. Zeki Çelen
,
Mustafa Yılmaz
,
Cumali Aktolun

Arch Med Sci 2015; 11, 2: 461–462
Online publish date: 2015/04/23
Article file
- pulmonary.pdf  [0.16 MB]
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
 
Pulmonary arteriovenous malformations are rare congenital abnormal connections between the pulmonary arteries and veins. The patients are usually asymptomatic [1]. Although their aetiology is unclear, it is presumed that genetic abnormalities constitute a predisposition [1, 2]. An arteriovenous malformation might cause serious complications if it remains undiagnosed and untreated [3].
We report a unique case of focal 18F-fluorodeoxyglucose (18F-FDG) uptake in a pulmonary arteriovenous malformation mimicking a mass lesion. A 74-year-old female patient with cyanosis and clubbing in her fingers and toes was referred to the Nuclear Medicine Department for positron-emission tomography (PET)/computed tomography (CT) imaging to assess a solitary pulmonary nodule with irregular margins in the right upper lobe detected on CT (Figure 1 A). The CT appearance suggested a malignant lesion. On 18F-FDG PET/CT, there was increased focal uptake in the pulmonary nodule, suggesting a mass lesion, possibly malignant (Figure 1 B). There is no described typical uptake pattern for arteriovenous malformations in FDG PET/CT images. 18F-FDG accumulation in a pulmonary mass suggests malignancy in most cases, although FDG accumulates in several benign conditions. Pulmonary angiography revealed afferent and efferent vessels with high contrast accumulation. Based on these findings, a pulmonary arteriovenous malformation was diagnosed. Subsequently, the patient underwent right video-assisted thoracoscopic surgery, a mini-thoracotomy, and wedge resection. The specimen confirmed the diagnosis of pulmonary arteriovenous malformation (Figure 2).
Pulmonary arteriovenous malformations are often diagnosed radiologically [4–6]. A chest X-ray might reveal a solitary nodule or be completely normal. Thorax CT is usually the second diagnostic tool in a patient with a suspected pulmonary arteriovenous malformation [7, 8], which causes dyspnoea and cyanosis in most cases [1, 3]. Pulmonary angiography gives the ultimate diagnostic information [4, 8]. The CT appearance of our patient’s arteriovenous malformation suggested a malignant solitary mass. The moderately increased FDG uptake also caused diagnostic confusion. There is no typical uptake pattern of arteriovenous malformations in FDG PET/CT images.

Conflict of interest

The authors declare no conflict of interest.

References

1. Gossage JR, Kanj G. Pulmonary arteriovenous malformations: a state of the art review. Am J Respir Crit Care Med 1998; 158: 643-61.
2. Benzinou M, Clermont FF, Letteboer TG, et al. Mouse and human strategies identify PTPN14 as a modifier of angiogenesis and hereditary haemorrhagic telangiectasia. Nat Commun 2012; 3: 616.
3. Sood N, Sood N, Dhawan V. Pulmonary arterioveneous malformation (AVM) causing hemothorax in a pregnant woman requiring emergent cesarean delivery. Pulm Med 2011; 2011: 865195.
4. Grzela K, Krenke K, Kulus M, Krenke R. Pulmonary arterioveneous malformations: clinical and radiological presentation. J Pediatr 2011; 158: 856-6.
5. Vittala SS, Demaerschalk BM, Huettl EA, Burke RF, Chaliki HP. Diagnosis of pulmonary arterioveneous malformation using a transesophageal exhocardiography bubble study. Eur J Echocardiogr 2011; 12: 664.
6. Das M, Odisio E, Loyalka P, Cheong BY. Large pulmonary arterioveneous malformation diagnosed by cardiovascular magnetic resonance. Tex Heart Inst J 2011; 38: 308-9.
7. Rankins S, Faling LJ, Pugatch RD. CT diagnosis of pulmonary arteriovenous malformation. J Comput Assist Tomogr 1982; 6: 746-9.
8. White RI, Lynch-Nyhan A, Terry P, Buescher PC. Pulmonary arteriovenous malformation, techniques and long-term outcome of embolotherapy. Radiology 1998; 169: 663-9.
Copyright: © 2015 Termedia & Banach. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
FEATURED PRODUCTS
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe