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Case Reports
. 2021 Mar 10;14(3):e240275.
doi: 10.1136/bcr-2020-240275.

Pulmonary arteriovenous malformation with metal allergy

Yoshiaki Takase  1 , Sachiko Nakano  2 , Ei Yamaki  3 , Osamu Kawashima  3
Affiliations
Case Reports

Pulmonary arteriovenous malformation with metal allergy

Yoshiaki Takase et al. BMJ Case Rep. .

Abstract

We present a rare case of single pulmonary arteriovenous malformation (PAVM) with multiple metal allergies, including for platinum. A 47-year-old woman presented to our hospital without any symptoms. Enhanced computed tomography showed a single PAVM in S6 of the right lung. Interviews prompted us to suspect a history of palmoplantar pustulosis associated with metal dental filling. Dermatology patch tests for metal allergy were positive for platinum, cobalt, tin and potassium dichromate. The first choice of treatment for PAVM is endovascular treatment using a metal coil. Since the coil is composed of platinum alloy, we performed partial lung resection for PAVM without metal implants. Although metal allergy is rare for endovascular treatment, it causes an additional stress of removal of causative metal or long-term steroidal treatment. Therefore, for single PAVM with multiple metal allergies to the implants, surgical treatment without metal implants should be considered.

Keywords: cardiothoracic surgery; dermatology; interventional radiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Chest radiograph showing an abnormal shadow at the right middle lung field (arrow). (B) CT scan on axial section. (C) CT scan on sagittal section showing a pulmonary arteriovenous malformation in the right lower lobe (arrow). (D) 3D-CT showing nidus from the feeding artery (A6) and drainage vein (V6) (dashed circle). (E) Postoperative chest radiograph acquired at 2-week follow-up.
Figure 2
Figure 2
Findings and surgical procedures during video-assisted thoracic surgery. (A) A pulmonary arteriovenous malformation (PAVM) was detected in S6. (B) A part of S6 lung parenchyma including the PAVM was resected using two clamping forceps (DeBakey aortic aneurysm clamp). (C) Stumps of the feeding artery and drainage vein were sutured with the surrounding lung parenchyma by Z-suture with 4–0 polypropylene. (D) The residual lung parenchyma of S6 was sutured by running locking suture with 4–0 polypropylene without releasing the clamp.
Figure 3
Figure 3
Pathological findings of the resected lung specimen. Cross section of the feeding artery (arrow) and drainage vein (arrow head).
See this image and copyright information in PMC

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