OVERVIEW
OVERVIEW
Pulmonary arteriovenous fistula is a rare disease of the pulmonary vascular anomalies characterized by the replacement of capillaries between the pulmonary arteries and veins by abnormal thin-walled blood vessels that form abnormal tubular traffic, resulting in varying degrees of right-to-left shunting, and the effects of these traffic branches on the body depend on the degree of vascular involvement.
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Department of Medicine
Respiratory medicine, thoracic surgery
Clinical symptoms
The main clinical symptoms include dyspnea and cyanosis after exertion, hemoptysis, and embolism.
Hazards
Emboli from the right side of the cardiovascular system can reach the body’s circulatory motor system through a pulmonary arteriovenous fistula, causing embolism or brain abscess with serious consequences.
Complications
Hemopneumothorax, cerebral ischemia, cerebral thrombosis, hemiparesis, and brain abscess.
Examination
X-ray radiography, echocardiography sonography, CT, etc.
Diagnosis
Diagnosis can be made on the basis of the manifestations of dyspnea and cyanosis after exertion, hemoptysis and embolism, combined with the findings of chest X-ray film, echocardiographic acoustic imaging and CT.
Treatment principle
If the diagnosis of pulmonary arteriovenous fistula is clear, regardless of whether there are symptoms or not, it should generally be treated surgically.
Curability
Timely and active treatment can achieve good results in most cases.
Dietary advice
Fasting is needed when the dyspnea is difficult to breathe, and light, easy-to-digest food should be eaten after it is relieved.
Causes
Causes
The causes of pulmonary arteriovenous fistula can be divided into congenital and acquired. Most pulmonary arteriovenous fistulas are caused by malformations of the pulmonary vasculature, and very few are caused by acquired pathologies such as inflammation of the lungs, lung tumors, parasites, trauma, etc. that invade the pulmonary vasculature and form fistulas between the pulmonary arteries and veins.
Questions you may be concerned about
Can cirrhosis cause pulmonary arteriovenous fistulas, are they diffuse?
Cirrhosis can cause pulmonary arteriovenous fistulas, not necessarily diffuse.
Cirrhosis is primarily a change in the normal structure of the liver due to massive necrosis of hepatocytes, fibrinoid proliferation, and pseudofollicular formation. This results in diminished inactivation of estrogen and microcapillary dilatation. Clinically, spider nevi and pulmonary arteriovenous fistulas are seen. Pulmonary arteriovenous fistulas can be subdivided into simple, complex and diffuse types.
Cirrhosis can cause pulmonary arteriovenous fistula clinically manifested as cyanosis, pestle finger. Especially after activity shortness of breath, cyanosis obvious. The mechanism is mainly due to the direct shunt from the pulmonary artery to the pulmonary vein, which can make the venous blood in the pulmonary artery directly shunt into the pulmonary vein without the gas exchange of the alveoli, and the patient has obvious cyanosis, hypoxemia, and it is difficult to correct with oxygen.
When there is a pulmonary arteriovenous fistula caused by cirrhosis, it should be treated according to the etiology of cirrhosis, and at the same time actively treat the complications. Effective relief of hypoxia symptoms, etc.
Cirrhosis patients all need to actively cooperate with doctors for treatment to avoid serious complications.
Symptoms and Diagnosis
Typical symptoms
The main clinical symptoms include dyspnea and cyanosis after exertion, hemoptysis and embolism. Neurological symptoms, such as convulsions, speech disorders, diplopia, temporary numbness, skin and mucosal vascular nevus and hemorrhagic symptoms can be seen in hereditary hemorrhagic capillary dilatation.
Diagnostic basis
1. The main clinical symptoms include dyspnea and cyanosis after exertion, hemoptysis, embolism, etc. 2. Chest X-ray shows single or multiple nodular and multicystic shadows in the lungs, which are connected with pulmonary vascular shadows. In different respiratory time phases, the size and shape of the larger tumor sacs change with the change of intrathoracic pressure. X-ray signs of multiple small arteriovenous fistulas or diffuse pulmonary arteriovenous malformations show diffuse nodular reticulation or uneven vascular texture in one or both lung fields.3. Echocardiographic acoustic imaging is clinically significant for diagnosis, and it can even detect those very small pulmonary arteriovenous fistulas.4. On chest CT, typical cases can see twisting and dilated blood-supplying and draining vessels connecting with them. The “tumor capsule” strengthens rapidly and significantly after enhancement. Multiple, diffuse pulmonary arteriovenous fistulas are characterized by numerous small nodules and reticular structures with enhanced and dilated vascular shadows. The diagnosis can be made on the basis of the typical presentation and examination findings.
Treatment
Treatment guidelines
If the diagnosis of pulmonary arteriovenous fistula is clear, it should generally be treated surgically, regardless of the presence or absence of symptoms. Small pulmonary arteriovenous fistulas that are extensive in both lungs cannot be treated surgically.
Surgical treatment
In infants and young children, surgery can be performed in childhood if symptoms are not severe. Small pulmonary arteriovenous fistulas that are extensive in both lungs cannot be treated surgically. In patients with hereditary hemorrhagic trichiasis, the pros and cons of surgical treatment should be carefully considered. Lobectomy or segmental resection of the lungs can be performed in most patients.
Other treatments
Aggressive treatment of the primary disease.
Prognosis
Approximately 50% of congenital pulmonary arteriovenous fistulas die in infancy. Acquired ones have a better prognosis, with only a few presenting with more serious consequences.
Nursing care
Daily care
Maintain indoor air circulation and control indoor temperature and humidity. Avoid upper respiratory tract infections.
Diet
Fasting is needed when the respiratory distress is relieved, and light, easy-to-digest food should be eaten.