Hereditary hemorrhagic telangiectasia with bilateral pulmonary vascular malformations – A case report

  • Olivera LJ Lončarević Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
  • Siniša Rusović Institute for Radiology, Military Medical Academy, Belgrade, Serbia
  • Marko Stojisavljević Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
  • Jelena Vuković Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
  • Goran Plavec Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Slobodan Aćimović Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
  • Gordana Cvetković Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
  • Marina Petrović Department of Pulmology, Clinical Centre Kragujevac, Faculty of Medicine Sciences, University of Kragujevac, Kragujevac, Serbia
Keywords: telangiectasia, hereditary hemorrhagic, arteriovenous malformations, lung diseases, hemoptysis, diagnosis, embolization, therapeutic, treatment outcome,

Abstract



Introduction. Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is an autosomal dominant disease that occurs due to vascular dysplasia associated with the disorder in the signaling pathway of transforming growth factor β (TGF-β). The clinical consequence is a disorder of blood vessels in multiple organ systems with the existence of telangiectasia which causes dilation of capillaries and veins, are present from birth and are localized on the skin and mucosa of the mouth, respiratory, gastrointestinal and urinary tract. They can make a rupture with consequent serious bleeding that can end up with fatal outcome. Since there is a disruption of blood vessels of more than one organic system, the diagnosis is very complex and requires a multidisciplinary approach. Case report. We reported a 40-year-old female patient with a long-time evolution of problems, who was diagnosed and treated at the Clinic for Lung Diseases of the Military Medical Academy in Belgrade, Serbia, because of bilaterally pulmonary arteriovenous malformations associated with HHT. Embolization was performed in two acts, followed with normalization of clinical, radiological and functional findings with the cessation of hemoptysis, effort intolerance with a significant improvement of the quality of life. Conclusion. HHT is a rare dominant inherited multisystem disease that requires multidisciplinary approach to diagnosis and treatment. Embolization is the method of choice in the treatment of arteriovenous malformations with minor adverse effects and very satisfying therapeutic effect.

Author Biography

Olivera LJ Lončarević, Clinic for Lung Diseases, Military Medical Academy, Belgrade, Serbia
Specijalista za plućne bolesti- Klinički lekar

References

Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, Mcdonald J, Proctor DD, et al. International Guidelines for the Diagnosis and Management of Hereditary Haemorrhagic Telangiectasia. J Med Genet 2011; 48(2): 73−87.

Lessnau K. Osler-Weber-Rendu Disease. 2014. Available from: http://emedicine.medscape.com/article/2048472-overview [cited 2014 June 2].

Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia PA: Saunders Elsevier; 2010.

Shovlin CL, Hughes JM, Scott J, Seidman CE, Seidman JG. Charac-terization of endoglin and identification of novel mutations in hereditary hemorrhagic telangiectasia. Am J Hum Genet 1997; 61(1): 68−79.

Folkman J, D'Amore PA. Blood vessel formation: What is its molecular basis. Cell 1996; 87(7): 1153−5.

Jones G, Robertson L, Harrison R, Ridout C, Vasudevan P. Somatic mosaicism in ACVRL1 with transmission to several offspring affected with severe pulmonary arterial hypertension. Am J Med Genet A 2014; 164(8): 2121−3.

Gallione CJ, Repetto GM, Legius E, Rustgi AK, Schelley SL, Tejpar S, et al. A combined syndrome of juvenile polyposis and here-ditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet 2004; 363(9412): 852−9.

Govani FS, Shovlin CL. Hereditary haemorrhagic telangiectasia: A clinical and scientific review. Eur J Hum Genet 2009; 17(7): 860−71.

Mager JJ, Overtoom TT, Blauw H, Lammers JW, Westermann CJ. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol 2004; 15(5): 451−6.

Ference BA, Shannon TM, White RJr, Zawin M, Burdge CM. Life-Threatening Pulmonary Hemorrhage With Pulmonary Arteri-ovenous Malformations and Hereditary Hemorrhagic Telan-giectasia. Chest 1994; 106(5): 1387−90.

Published
2017/03/08
Section
Case report