Arterio Venous Malformation of Tongue Presenting with Bleeding in Pregnancy.

Arterio venous malformation (AVM) of the tongue is a rare craniofacial vascular anomaly. It occurs due to the failure of complete involution of fetal capillary bed leading to the development of abnormal connections between arteries and veins. It can present with diff erent clinical presentations and radiographic findings. It may be overlooked at birth due to its innocent appearance. Progression of the AVMs is commonlyinduced by puberty, trauma, and pregnancy. Furthermore, some forms of treatment, including ligation of arterial feeders, partial excision, incomplete arterial embolization, and laser treatment can trigger progression of quiescent AVMs. Progression of AVMs in pregnancy can sometimes lead to torrential hemorrhage. Th is can endanger the life of the mother and fetus. We report a case of a 22-year-old primigravida referred of our institution at 35 weeks 3 days gestation with intrauterine fetal death and severe anemia, due to profuse bleeding from an AVM of the tongue.

Malformación arteriovenosa pulmonar: características clínicas, diagnóstico y rol del tratamiento quirúrgico en pacientes tratados con cirugía resectiva pulmonar / Pulmonary arteriovenous malformation: clinical features, diagnosis and role of surgical management in patients with lung resection surgery

Introducción: Las malformaciones arteriovenosas pulmonares (MAVP) son infrecuentes y la cirugía tiene un rol en casos seleccionados. Objetivos: Describir las características clínicas, métodos diagnósticos y rol del tratamiento quirúrgico en pacientes tratados con cirugía por MAVP. Materialy Método: Revisión retrospectiva, incluyendo todos los pacientes con diagnóstico de MAVP en quienes se realizó cirugía en el Instituto Nacional del Tórax, desde febrero de 2005 a febrero de 2010. El seguimiento fue por control médico o contacto telefónico. Resultados: Se analizó 8 pacientes, seis mujeres (relación 3:1), edad entre 16 y 68 años. Los síntomas y signos más frecuentes fueron: disnea, cianosis y acropaquia. La localización más frecuente fue el lóbulo inferior derecho. Cuatro pacientes tenían MAVP múltiples y cuatro cumplían con criterios de Enfermedad de Rendu-Osler-Weber Seis tenían policitemia y dos anemia. La radiografía fue anormal en todos los casos y la tomogrqfía computada definió la anatomía en siete. Angiogrqfia se realizó en tres casos. Dos tenían ecocardiograma con contraste y cuatro cintigrama. La cirugía más frecuente fue la lobectomía. La indicación de cirugía fue: tamaño de la MAVP en cinco, falla de embolización en dos y hallazgo intra operatorio en uno, intervenido por otra razón. Uno presentó hemorragia post-operatoria. La estadía post-operatoria fue entre 2 y 10 días. No hubo mortalidad. En el último control todos los pacientes estaban asintomáticos. Conclusión: Las MAVPpueden presentarse en un amplio espectro clínico y anatómico. Pueden generar síntomas y complicaciones graves, por esto se recomienda tratarlas. El estudio pre-operatorio se basa en demostrar el shunt y en determinar las características anatómicas de la lesión. En algunos casos seleccionados está indicada la cirugía resectiva pulmonar.

Background: Pulmonary arteriovenous malformations (PA VM) are rare and surgery has a role only in selected cases. Our objectives are to describe clinical features, diagnostic methods and role of surgical treatment in patients with PA VM. Methods: Retrospective review of all patients with PA VM, in whom surgery was performed in our institution, from February 2005 to February 2010. The follow up controls were done through physician or telephone contact. Results: 8 patients, six females (3:1), aged between 16-68 years were analyzed. Most common sigiis and symptoms were dyspnea, cyanosis and clubbing. Right lower lobe was the most frequent location. Four had multiple PA VM and four met criteria for Rendu-Osler- Weber disease. Six patients had polycythemia and two anemia. Radiography was abnormal in all and computed tomography defined anatomy in seven. Angiography was performed in three, two had contrasted echocardiography and four had scintigraphy. Most common surgical treatment was lobectomy. Indications for surgery were the size of PA VM in five cases, failure of embolization in two and one because of intra-operative findings, without a previous diagrwsis. One had postoperative bleeding. Discharge was between day 2 and 10 days after surgery. There was no mortality. At their last control all patients were asymptomatic. Conclusion: PA VM presents a wide and varied range of clinical and anatomical findings. They can cause major symptoms and serious complications, which justify their treatment. The preoperative study is based primarily on demonstrating the shunt and determining the anatomical characteristics of the lesion. In selected cases lung resection surgery is indicated.

Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population

Hemangioma, vascular malformation and varix are benign vascular lesions, common in the head and neck regions. Studies about the prevalence of these lesions in the oral cavity are scarce. The aim of this study was to estimate the prevalence of and to obtain clinical data on oral hemangioma, vascular malformation and varix in a Brazilian population. Clinical data on those lesions were retrieved from the clinical forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal University of Minas Gerais, Brazil, from 1992 to 2002. Descriptive analysis was performed. A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154 (6.4 percent) cases were categorized as oral hemangioma, oral vascular malformation or oral varix. Oral varix was the most frequent lesion (65.6 percent). Females had more oral hemangioma and oral varix than males. Oral vascular malformation and oral varix were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and oral varix were more prevalent in the ventral surface of the tongue and oral vascular malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5 percent), and vascular malformation was managed with sclerotherapy and surgery (19.4 percent each). The data of this study suggests that benign vascular lesions are unusual alterations on the oral mucosa and jaws.

Hemangioma, malformação vascular e variz são lesões vasculares benignas comuns na região de cabeça e pescoço. Estudos sobre a prevalência dessas lesões em boca são escassos. O objetivo deste estudo foi estimar a prevalência e realizar um levantamento de dados clínicos de hemangioma, malformação vascular e variz de boca. Dados clínicos dessas lesões foram consultados em fichas clínicas do arquivo do Serviço de Diagnóstico Oral da Universidade Federal de Minas Gerais, Brasil, no período de 1992 a 2002. Uma análise descritiva foi realizada. Foram obtidas neste período de 10 anos 2.419 fichas clínicas. Cento e cinqüenta e quatro (6,4 por cento) casos foram categorizados como hemangioma, malformação vascular e variz de boca. Variz de boca foi a lesão mais freqüente (65,6 por cento). Mulheres foram mais acometidas pelos hemangiomas e varizes de boca. Malformação vascular e variz de boca foram mais prevalentes na 7ª e 6ª décadas de vida, respectivamente. A localização prevalente do hemangioma e da variz de boca foi a superfície ventral da língua, e da malformação vascular, os lábios. Hemangioma de boca foi tratado com escleroterapia em 54,5 por cento dos casos e a malformação vascular com escleroterapia e cirurgia em 19,4 por cento cada. Este estudo sugere que lesões vasculares benignas são alterações incomuns na mucosa bucal e nos maxilares.