J Korean Med Sci.  2009 Apr;24(2):330-332. 10.3346/jkms.2009.24.2.330.

A Case of Successful Surgical Treatment of Migraine Headaches in a Patient with Sporadic Pulmonary Arteriovenous Malformations

• Na SJ
• Cho HM
• Park JS

• KMID: 1779140
• DOI: http://doi.org/10.3346/jkms.2009.24.2.330

Abstract

Pulmonary arteriovenous malformations (PAVMs) are thin-walled aneurysms caused by abnormal communication between the pulmonary arteries and veins. Migraine headaches are sometimes the presenting clinical manifestation of PAVMs. Although embolotherapy, using detachable balloons or stainless steel coils, is generally accepted as the best choice for the treatment of multiple PAVMs, the mode of intervention for solitary PAVMs remains a subject of debate. We present a 43-yr-old woman with a 10-yr history of chronic migraines and dyspnea on exertion. She was discovered to have a large solitary centrally located PAVM, placing her at high risk of complications if she were to undergo percutaneous transcatheter embolization. She underwent successful surgical resection of her right middle lobe without complications, resulting in subsequent symptomatic improvement.

Keyword

Migraine Headaches; Pulmonary Arteriovenous Malformations; Surgical Resection

MeSH Terms

Adult
Arteriovenous Malformations/diagnosis/*surgery
Female
Humans
Magnetic Resonance Angiography
Migraine Disorders/diagnosis/*surgery
Pulmonary Artery/*abnormalities
Pulmonary Veins/*abnormalities
Thoracotomy
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A) Chest computed tomography scan with contrast enhancement shows a large, well-enhanced nodular lesion of the right middle lobe. (B) Selective angiogram of the right middle lobe demonstrates a 1 cm-sized feeding artery (FA), a similar sized draining vein (DV), and about a 2 cm sized arteriovenous malformation (AVM). (C) Large pulsatile pulmonary arteriovenous malformation in the right middle lobe as seen during the operation.

Reference

1. Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med. 1998. 158:643–661.

2. White RI Jr, Pollak JS, Wirth JA. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Interv Radiol. 1996. 7:787–804.

3. Guttmacher AE, Marchuk DA, White RI Jr. Hereditary hemorrhagic telangiectasia. N Engl J Med. 1995. 333:918–924.

4. Moussouttas M, Fayad P, Rosenblatt M, Hashimoto M, Pollak J, Henderson K, Ma TY, White RI. Pulmonary arteriovenous malformations: cerebral ischemia and neurologic manifestations. Neurology. 2000. 55:959–964.

5. White RI Jr, Lynch-Nyhan A, Terry P, Buescher PC, Farmlett EJ, Charnas L, Shuman K, Kim W, Kinnison M, Mitchell SE. Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy. Radiology. 1988. 169:663–669.

6. Nanthakumar K, Graham AT, Robinson TI, Grande P, Pugash RA, Clarke JA, Hutchison SJ, Mandzia JL, Hyland RH, Faughnan ME. Contrast echocardiography for detection of pulmonary arteriovenous malformations. Am Heart J. 2001. 141:243–246.

7. Post MC, Letteboer TG, Mager JJ, Plokker TH, Kelder JC, Westermann CJ. A pulmonary right-to-left shunt in patients with hereditary hemorrhagic telangiectasia is associated with an increased prevalence of migraine. Chest. 2005. 128:2485–2489.

8. Thenganatt J, Schneiderman J, Hyland RH, Edmeads J, Mandzia JL, Faughnan ME. Migraines linked to intrapulmonary right-to-left shunt. Headache. 2006. 46:439–443.

9. Steele JG, Nath PU, Burn J, Porteous ME. An association between migrainous aura and hereditary haemorrhagic telangiectasia. Headache. 1993. 33:145–148.

10. Wilmshurst P, Nightingale S. Relationship between migraine and cardiac and pulmonary right-to-left shunts. Clin Sci (Lond). 2001. 100:215–220.

11. Terry PB, Barth KH, Kaufman SL, White RI Jr. Balloon embolization for treatment of pulmonary arteriovenous fistulas. N Engl J Med. 1980. 302:1189–1190.

12. James RG, Ghassan K. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med. 1998. 158:643–661.

13. Post MC, Thijs V, Schonewille WJ, Budts W, Snijder RJ, Plokker HW, Westermann CJ. Embolization of pulmonary arteriovenous malformations and decrease in prevalence of migraine. Neurology. 2006. 66:202–205.