Pulmonary Arteriovenous Malformation Presenting as Brain Abscess

肺動靜脈畸形以腦部膿瘍表現－病例報告及文獻回顧

邱鈺棋(Yu-Chi Chiu) ； 江啟輝(Chi-Huei Chiang)

《胸腔醫學》 23卷4期 (2008/08) Pp. 310-315

https://doi.org/10.29806/TM.200808.0012

摘要

肺部動靜脈畸形常是和遺傳性出血性毛細血管擴張有關，在無症狀的肺動靜脈畸形病人初期可以以腦膿瘍來表現。不熟悉這個疾病常會將之歸類為其他原因。在此報告一位六十三歲女性一開始的神經學症狀為暈眩和頭暈有五年的時間，而在近兩個星期有症狀加重的現象，腦部電腦斷層發現有腦部膿瘍，這位女性病人接受立體定位膿瘍抽吸術，胸部電腦斷層血管攝影竟發現肺部動靜脈畸形，之後開胸手術切除了肺部病灶，病理檢查證實了肺動靜脈畸形的診斷。腦部膿瘍合併肺靜脈畸形非常少見，所以在不明原因的腦部膿瘍，要考慮肺動脈畸形的可能性。

關鍵字

肺動靜脈畸形 ； 腦膿瘍 ； 遺傳性出血性毛細血管擴張

並列摘要

Pulmonary arteriovenous malformation (PAVM) is often associated with hereditary hemorrhagic telengiectasia. Brain abscess can be the initial manifestation of PAVMs. Because of a lack of awareness of this condition and inadequate screening, physicians often misdiagnose PAVMs. We report a 63-year-old female who had the initial neurological symptoms of vertigo and dizziness for about 5 years, which worsened in the 2 weeks prior to admission. Brain CT showed 2 brain abscesses and she received stereotactic aspiration. PAVM was diagnosed by CT-angiography which showed an arteriovenous malformation with aneurysmal formation in the left upper lung; this was confirmed by surgical resection. Case reports of brain abscesses associated with PAVMs are very rare. Therefore, an association with PAVMs should be considered in cases of brain abscesses of undetermined etiology.

並列關鍵字

pulmonary arteriovenous malformations PAVM ； brain abscess ； hereditary hemorrhagic telengiectasia HHT