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Il Giornale Italiano di Radiologia Medica 2019 Luglio-Agosto;6(4):321-7

DOI: 10.23736/S2283-8376.19.00207-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Embolization of systemic-to-pulmonary artero venous malformation secondary to Mycobacterium Tuberculosis empyema necessitans

Pietro BOSCARATO 1, Marzia ROSATI 1, Fabio SALVATORI 2, Marco MACCHINI 1 , Salvatore ALBORINO 1, Enrico PACI 1, Roberto CANDELARI 1

1 Unit of Interventional Radiology, Department of Radiology, OORR-Torrette University Hospital, Ancona, Italy; 2 School of Radiology, Polytechnic University of Marche Region, Ancona, Italy


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Pulmonary arteriovenous malformations are abnormal vessels that connect arterial and venous pulmonary circulations. Vascular malformation secondary to tuberculosis empyema necessitans represents a rare condition. We report a case of a 43-year-old woman native of Peru with a history of empyema necessitans post-tuberculosis at left pulmonary upper lobe. The patient has accepted to our emergency department for recurrent episodes of severe hemoptysis. A computed tomography scan showed the presence of a vascular malformation at left pulmonary upper lobe. The vascular malformation was treated with endovascular approach in two steps. During the first procedure, an embolization of the left upper bronchial artery was performed with liquid embolic agent (Onyx™ 34). Due to recurrence of hemoptysis, we planned a new procedure with double vascular access (femoral artery and vein). At first, we reached the pulmonary arteries that communicated with the vascular malformation and we embolized these vessels with detachable and pushable coils. Then, feeder vessels from left subclavian and left internal mammary arteries were embolized with liquid embolic agent (Onyx™ 34). Final angiography showed complete occlusion of the vascular malformation. Vascular malformations secondary to tuberculosis empyema necessitans represent complex conditions and a challenge for the interventional radiologist: on the other hand, the endovascular treatment is safe and effective although it may require more than one procedure.


KEY WORDS: Arteriovenous malformations; Empyema, tuberculous; Embolization, therapeutic

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