HAL Id: hal-00572134
https://hal.archives-ouvertes.fr/hal-00572134
Submitted on 1 Mar 2011
HAL is a multi-disciplinary open access archive for the deposit and dissemination of sci- entific research documents, whether they are pub- lished or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.
L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Images in vascular medicine
Oliver K Mohrs, Markus K Heinemann, Dieter Eckhardt, Bernd Nowak, Hans-Ulrich Kauczor, Thomas Voigtlaender
To cite this version:
Oliver K Mohrs, Markus K Heinemann, Dieter Eckhardt, Bernd Nowak, Hans-Ulrich Kauczor, et al.. Images in vascular medicine. Vascular Medicine, SAGE Publications, 2006, 11 (1), pp.53-54.
�10.1191/1358863x06vm648xx�. �hal-00572134�
Vascular Medicine 2006; 11: 53–54
© 2006 Edward Arnold (Publishers) Ltd 10.1191/1358863x06vm648xx
Images in vascular medicine
Morphologic and functional assessment of extensive pulmonary arteriovenous malformations using MRI
Oliver K Mohrsa,b, Markus K Heinemannc, Dieter Eckhardtd, Bernd Nowake, Hans-Ulrich Kauczorband Thomas Voigtlaendere
aDarmstadt Radiology at Alice-Hospital, Darmstadt, Germany;
bGerman Cancer Research Center (DKFZ), Heidelberg, Germany;
cUniversity of Mainz, Mainz, Germany; dCardiac Center Offenbach, Offenbach, Germany; eCardiovascular Center Bethanien, Frankfurtam Main, Germany
Address for correspondence: Oliver K Mohrs, Darmstadt Radiology, Department of Cardiovascular Imaging at Alice-Hospital, Dieburger Strasse 29–31, D-64287 Darmstadt, Germany. E-mail:
o.mohrs@gmx.de Tel:⫹49 6151 13940; Fax:⫹49 6151 139430;
Panel A Panel B
A 17-year-old woman had suffered from dyspnoea and cyanosis since childhood. Physical examination revealed central and peripheral cyanosis. Auscultation of the heart and lungs was unremarkable. Arterial blood gas analysis demonstrated an oxygenation saturation of 83%. This did not improve during inhalation of oxygen.
Echocardiography showed good left ventricular func- tion; the ventricles and atria were not enlarged.
Intracardiac shunts, patent ductus arteriosus and valve disease were excluded.
Intravenous administration of D-galactose-microbub- bles caused an enhancement of the left atrium and ventri- cle, consistent with an intracardiac or extracardiac shunt.
A chest radiograph showed diffuse opacities in the periphery of the right lung (Panel A, arrows). Owing to the differential diagnosis of abnormal pulmonary vascu- lature, the patient was referred for cardiovascular MRI.
Panel C
Using contrast-enhanced MR angiography we found multiple arteriovenous malformations mainly in the upper and middle lobe of the right lung (Panel B, arrows;
PA⫽pulmonary artery, PV⫽pulmonary vein). These were not configured in a typical way as nodular struc- tures with feeding (Panel C, dotted arrow) and draining vessels (Panel C, curved arrow), but showed a reticular pattern.
Velocity-encoded MRI-based flow measurement excluded a left-to-right shunt comparing flow volumes of the main pulmonary arteries and ascending aorta.
In order to quantify the intrapulmonary shunt volume we performed further flow measurements in the segmental pulmonary veins draining the three main malformations.
Over 30% of the pulmonary blood flow shunted through the arteriovenous malformations, explaining decreased blood oxygen saturation, the dyspnoea and the abnor- mal findings of contrast-enhanced echocardiography.
In our report, we present the potential of MRI to detect even very rare malformations of the pulmonary vascula- ture and to allow for functional assessment of haemody- namic parameters.
54 OK Mohrs et al
Vascular Medicine 2006; 11: 53–54
