PubMed · 12793176
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Odile Enjolras. 2003-04-15. [Angiomas].. https://pubmed.ncbi.nlm.nih.gov/12793176/
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Misalignment of lung vessels represents a rare congenital anomaly that may cause respiratory failure in the newborn. It is characterized by abnormal position of pulmonary veins and venules that lie adjacent to arteries and bronchi, and it is usually associated with a decreased number of alveolar capillaries (i.e., alveolar capillary dysplasia), although these two conditions have been separately described. Awareness of this anomaly is required by pathologists because it can be easily overlooked on lung biopsy or autopsy, and because definite diagnosis relies on histology. We report the case of a newborn male baby who developed respiratory distress 18 h after an uncomplicated delivery. The patient died on the 7th day, after high frequency oscillatory ventilation, nitric oxide inhalation and extracorporeal membrane oxygenation were unsuccessful. On autopsy, histology and immunohistochemistry demonstrated diffuse changes, fulfilling diagnostic criteria of misalignment of lung vessels and of alveolar capillary dysplasia in both lungs, with muscularization of very peripheral pulmonary arteries and a prominent interstitial and periadventitial fibrosis. Diffuse distribution of vessel misalignment could explain the rapid onset of respiratory failure, and the presence of diffuse fibrosis might have contributed to irreversible respiratory dysfunction by impairment of lung parenchyma extensibility.
An arteriovenous malformation (AVM) is an anomaly of capillary development that results in a direct connection between branches of an artery and veins, with no intervening capillary network. A definite diagnosis of AVM is usually made with angiography. We report the case of a posterior mediastinal AVM found on routine sonography in a 64-year-old woman with neglected hypertension and severe back pain. Color Doppler imaging showed 2 adjoined vascular structures without a typical mosaic-like flow pattern, and spectral Doppler analysis showed low-resistance flow and arteriovenous shunting in 2 adjoined vascular structures. The diagnosis was subsequently confirmed by angiography. Because disastrous bleeding could result if needle biopsy were performed inadvertently in the case of a suspected mediastinal AVM, we suggest that color Doppler sonography be attempted if there is an adequate acoustic window.
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