A Senile Patient with Rendu-Osler-Weber Disease who Underwent Resection of 4 Multiple Bilateral Pulmonary Arteriovenous Fistulas

Abstract

A 70-year-old female patient with multiple bilateral pulmonary arteriovenous fistulas was referred to our hospital for its treatment. She had experienced frequent epistaxis and had nasopharyngeal telangiectasia. Her mother, sister and all four children also suffered from epistaxis. We diagnosed this patient as Rendu-Osler- Weber disease combined with multiple bilateral pulmonary arteriovenous fistulas. Her chest roentgenogram revealed 4 arteriovenous fistulas in the left lung and 2 arteriovenous fistulas in the right. On admission arterial blood gas analysis while breathing room air showed a PaO₂ of 39.8 torr and an SaO₂ of 75.4%. The percent of R-L shunt was calculated to be 56.5%. Because of severe hypoxemia, she underwent resection of four large fistulas in segments 3, 4, 5, and 8 of the left lung. Twenty-eight days after the operation, the PaO₂ was 76.4 torr and SaO₂ was 95.7%. There was no sign of enlargement in size of the remaining arteriovenous fistulas.