원인불명 색전뇌경색 환자에서 폐동정맥루 단순 흉부 방사선 사진 소견

Simple Chest Radiography Findings of Pulmonary Arteriovenous Fistula in Patients with Otherwise Cryptogenic Ischemic Stroke

Article information

J Korean Neurol Assoc. 2018;36(3):252-253

Publication date (electronic) : August 1, 2018

doi : http://dx.doi.org/10.17340/jkna.2018.3.27

Seong-Hoon Kim, MD , Dae-Woong Bae, MD ^a, Taewon Kim, MD^,^b

Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea

^aDepartment of Neurology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea

^bDepartment of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea

김성훈, 배대웅^a, 김태원^,^b

가톨릭대학교 의정부성모병원 신경과

^a가톨릭대학교 성빈센트병원 신경과

^b가톨릭대학교 인천성모병원 신경과

Address for correspondence: Taewon Kim, MD Department of Neurology, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 24131, Korea Tel:+82-32-280-5010 Fax: +82-32-280-5244 E-mail: kimtaewon@catholic.ac.kr

received : December 23, 2017 , rev-recd : February 27, 2018 , accepted : February 27, 2018 .

모순색전(paradoxical embolic)뇌경색으로 방문한 두 명의 환자(46세, 56세 여자 환자)가 단순 흉부방사선사진에서 이상을 보여, 흉부전산단층혈관촬영을 통해 폐동정맥루(pulmonary arteriovenous fistula)를 진단하였다. 두 환자의 단순흉부방사선사진에서는 둥근 타원형 모양의 경계가 분명하고, 균질한 혼탁의 병변을 보였다(Fig. 1, 2). 이 병변은 조영증강 흉부전산단층혈관촬영을 통해 폐동정맥루로 확진되었다. 원인불명의 색전뇌경색에서 폐동정맥루는 색전 원인의 중요한 감별진단 중에 하나이다. 이를 위한 선별검사인 단순흉부 방사선사진에서는, 일반적으로 연조직 음영의 종괴로 보이나, 주변의 혈관음영과는 다른 방향성을 보인다[1].

Figure 1.

46-year-old woman with embolic infarction. Chest X-rays (A) revealed round mass with sharply defined border (red arrow) which were confirmed as PAVM by contrast-enhanced chest CT (B). Diffusion weighted images demonstrated ischemic lesion in left angular gyrus (C). PAVM; pulmonary arteriovenous malformation, CT; computed tomography

Figure 2.

56-year-old woman with embolic infarction. Chest X-rays (A) demonstrated ovoid convoluted mass with demarcated border (red arrow) which were diagnosed as PAVM by contrast-enhanced chest CT angiography (B). Diffusion weighted images demonstrated ischemic lesion with hemorrhagic transformation in left cerebellum (C). PAVM; pulmonary arteriovenous malformation, CT; computed tomography.

References

1. Lacombe P, Lacout A, Marcy PY, Binsse S, Sellier J, Bensalah M, et al. Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: an overview. Diagn Interv Imaging 2013;94:835–848.

Article information

References

Article information Continued

Figure 1.

Figure 2.