Online publication August 10, 症例報告 要旨 : S3 S10 S CT S3 S S3 S10 J Jpn Coll Angiol 2013; 53:
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1 Online publication August 10, 症例報告 要旨 : S3 S10 S CT S3 S S3 S10 J Jpn Coll Angiol 2013; 53: Key words: pulmonary arteriovenous malformation, enlargement, recanalization 序言 mm 1 2, 3 18 X 症例 X S3 S10 S3 10 mm A3b simple type 2 mm S10 30 mm A10b A10c complex type 3 mm 11 A10b Helix 5 mm 15 cm 2 BOD coil 4 A10c Helix 6 mm 20 cm 2 Helix 4 mm 8 cm Helix 4 mm 12 cm X CT S3 S S3 20 / doi: /jca
2 122 A C B D Figure 1 (A, B, C) Chest enhanced-ct showing a pulmonary arteriovenous fistula in right S3 and Feeding artery ( ) measured 4.5 mm in diameter. (D) Compared with chest enhanced-ct performed on first presentation (1994), the pulmonary arteriovenous fistula and feeding artery in right S3 has enlarged. 156 cm 53 kg 123/62 mmhg 68/ 35.7 SpO 2 98 WBC 8700/μg SEG 49.7 EO 2.2 BA 0.3 MO 4.3 LY 43.5 RBC /μl HGB 14.2 g/dl HCT 41.6 MCV 88.5 fl MCH 30.2 pg MCHC 34.1 PLT /μl GOT 15 U/l GPT 12 U/l LDH 197 U/l ALP 224 U/l γ-gtp 21 U/l TP 7.4 g/dl ALB 4.4 g/dl TG 165 mg/dl UA 4.9 mg/dl UN 12 mg/dl CRE 0.68 mg/dl T-BIL 0.6 mg/dl C-BIL 0.0 mg/dl T-CHO 182 mg/dl Na 138 mmol/l K 3.9 mmol/l Cl 104 mmol/l APTT 30.6 sec PT 10.6 sec PT 105 PT-INR 0.94 D-dimer 0.3 μg/ml CRP 0.0 mg/dl 100 ph 7.46 PaCO 2 33 Torr PaO Torr Q S/Q T X S10 S3 CT Fig. 1A C S mm A3b 4.3 mm CT Fig. 1D 16 S3 10 mm mm A3b 2 mm 4.3 mm S10 4D A10b Fig. 2 S3 Fig. 3A 7Fr 4Fr A3b Interlock 6 mm 20 cm Interlock 5 mm 15 cm Orbit Galaxy Complex Fill 5 mm 15 cm 4 mm 12 cm 3.5 mm 9 cm 3 mm 8 cm Trufill Pushable Complex 5 mm 4 cm 3 4 mm 3 cm 脈管学 Vol. 53
3 123 Figure 2 Four-dimensional (4D) CT suggesting recanalization of the fistula in left S10 from left A10b. A B Figure 3 (A) A right oblique view of an angiogram of the right pulmonary artery showing a well-defined fistula before coil embolization. (B) The fistula disappeared after coil embolization. Fig. 3B 右 S3 肺動静脈瘻のコイル塞栓術後 左肺動脈造影を 行ったところ 1994 年にコイル塞栓を行った左 S10 肺動 静脈瘻で左 A10b からの再疎通を認めた Fig. 4 こちら については今後コイル塞栓術を再度行うこととした コイル塞栓術後の胸部造影 CT では右 S3 肺動静脈瘻の 再疎通は認めず また 合併症もなく 術後 7 日目に退 院となった 1 年後の経過観察の胸部造影 CT でも右 S3 肺動静脈瘻 の再疎通は認めなかった 左 S10 肺動静脈瘻に対しては 2012 年 9 月にコイル塞栓術を施行した 両病変ともに今 後も慎重な経過観察を継続していく予定である Figure 4 A frontal view of an angiogram of the left pulmonary artery showing a recanalization of the pulmonary arteriovenous fistula in left S10 from left A10b.
4 124 考察 hereditary hemorrhagic telangiectasia; HHT 4 1 simple type 2 complex type Pollak X 20 mm 3 mm 6 Milic 10 mm 7 Hayashi 8 Remy-Jardin Mager Trerotola X X CT CT 3D 4D CT 10, 11 4D CT CT 文献 1 Gossage JR, Kanj G: Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med 1998; 158: Remy-Jardin M, Dumont P, Brillet PY, et al: Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2 21-year follow-up. Radiology 2006; 239: Mager JJ, Overtoom TT, Blauw H, et al: Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol 2004; 15: Vase P, Holm M, Arendrup H: Pulmonary arteriovenous fistulas in hereditary hemorrhagic telangiectasia. Acta Med Scand 1985; 218: Pollak JS, Saluja S, Thabet A, et al: Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol 2006; 17: 35 44; quiz 45 6 Pugash RA: Pulmonary arteriovenous malformations: overview and transcatheter embolotherapy. Can Assoc Radiol J 2001; 52: Milic A, Chan RP, Cohen JH, et al: Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol 2005; 16: 脈管学 Vol. 53
5 125 8 Hayashi S, Baba Y, Senokuchi T, et al: Efficacy of venous sac embolization for pulmonary arteriovenous malformations: comparison with feeding artery embolization. J Vasc Interv Radiol 2012; 23: Trerotola SO, Pyeritz RE: PAVM embolization: an update. AJR Am J Roentgenol 2010; 195: D-MDCT ; 43: CT 2011; 49: A Case of Pulmonary Arteriovenous Fistulas Which Showed Enlargement of the Other Fistula and Recanalization of the Treated Fistula after Coil Embolization at Postoperative Remote Term Hajime Kasai, 1 Takato Sato, 2 Yasunori Kasahara, 1 Toshihiko Sugiura, 1 Takashi Higashide, 3 Rika Suda, 1 Fumiaki Kato, 1 Takao Takeuchi, 1 Seiichiro Sakao, 1 Nobuyuki Tanabe, 1 and Koichiro Tatsumi 1 1Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan 2 School of Medicine, Chiba University, Chiba, Japan 3 Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan Key words: pulmonary arteriovenous malformation, enlargement, recanalization In 1994, a 42-year-old woman was diagnosed with two pulmonary arteriovenous fistulas in right S3 and left S10. Coil embolization was performed for the left S10 fistula. In September 2010, chest enhanced computed tomography (CT) showed enlargement of the other fistula and recanalization of the treated fistula. Coil embolization was performed in the right S3 fistula the following year. Angiogram of left pulmonary artery displayed recanalization of the fistula in left S10. Pulmonary arteriovenous fistula may grow in natural course. In addition, recanalization after coil embolization should be noted. Therefore, regular follow-up using enhanced computed tomography is necessary. (J Jpn Coll Angiol 2013; 53: ) Online publication August 10, 2013
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