Plućna arteriovenska malformacija
Sažetak
Uvod. Plućna arteriovenska malformacija (PAVM) je patološka komunikacija između plućne arterije i plućne vene kojom se zaobilazi normalna alveo-kapilarna membrana, usled čega se krv u tom delu plućnog parenhima ne oksigeniše. Savremeni pristup lečenju PАVM uključuje hirurški tretman ili embolizaciju endovaskularnim putem. Prikaz bolesnika. Bolesnica stara 30 godina javila se zbog trnjenja i slabosti ekstremiteta leve strane. Objektivno, imala je cijanozu usana i batičaste prste. Na radiografiji srca i pluća, u desnom hemitoraksu, u donjem plućnom polju u projekciji medioklavikularne linije, nwwađena je relativno homogena i relativno jasno ograničena senka promera oko 35 mm, intenziteta mekih tkiva. Urađena je multislajsna kompjuterizovana tomografija sa pulmoangiografijom i u plućnom parenhimu, obostrano, utvrđen je veći broj PAVM, od kojih je najveća (promera oko 35 mm) bila u donjem desnom plućnom režnju na prelazu između apikalnog i posterobazalnog segmenta, sa uočljivom dovodnom arterijom prečnika oko 7 mm i odvodnom venom prečnika oko 9 mm. Primenom Seldingerove metode urađena je selektivna pulmoangiografija. Kroz uvodnik, uveden je „čepić“ (eng. plug) prečnika 10 mm, „čepić“ je ekspandiran, čime je indukovana potpuna okluzija završnog dela dovodne grane te PAVM (potvrđeno kontrolnom angiografijom). Na taj način, PAVM je u potpunosti bila isključena iz cirkulacije. Tokom tri meseca praćenja, bolesnica se osećala dobro i nisu zabeležene nikakve komplikacije. Zaključak. Endovaskularna embolizacija se preporučuje kao terapija prvog izbora za sve PAVM čija arterija hranilica ima dijametar veći od 2 mm. Endovaskularna embolizacija pokazuje visoku stopu uspešnosti sa minimalnom stopom komplikacija.
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