A case of resected giant pulmonary arteriovenous fistula presenting concurrently with brain abscess

Abstract

A 41-year-old woman visited a local physician with the complaint of a headache. A prescription analgesic was not effective and, 2 days later, the patient visited the Department of Neurosurgery with a visual field defect. Computed tomography (CT) of the brain revealed the presence of a 35×27-mm brain abscess and surrounding brain edema. Contrast-enhanced CT of the chest on admission demonstrated a 50×36-mm tumor, feeding artery, and draining vein in the left S⁹ segment. Based on these findings, the patient was diagnosed with pulmonary arteriovenous fistula. Emergent cranial drainage was performed and antibiotic therapy was infused continuously for approximately 6 weeks. After the resolution of the brain abscess and edema was confirmed on a brain CT, surgical treatment for pulmonary arteriovenous fistula was performed and a 5-cm white and purple tumor was found protruding from the pulmonary surface of the left lower lobe. First, the inferior pulmonary vein was stapled in order to avoid iatrogenic air embolism or thrombosis embolism during the surgery. Next, the artery and bronchus were stapled and the lower lobe removed. Recently, trans-catheter arterial embolization has been widely used for the treatment of pulmonary arteriovenous fistula. Surgical treatment can be one of the effective treatment options, depending on the size and location of the tumor, and the diameters of the feeding and draining blood vessels.