ABSTRACT
A pregnant woman presented with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and a single pulmonary arteriovenous malformation (AVM) that had been embolized 5 years previously. Partly due to pregnancy, recanalization of the aneurysm occurred with subsequent hemoptysis. Despite successful therapeutic reembolization of the afferent pulmonary artery, hemoptysis recurred 5 days later. At this time, recanalization of the pulmonary artery was not demonstrated by pulmonary angiography, but a systemic angiogram revealed a bronchial arterial supply to the pulmonary AVM. A systemic supply should always be sought in cases of recurrent hemoptysis after technically successful embolization of the feeding pulmonary artery.
Subject(s)
Arteriovenous Malformations/therapy , Bronchial Arteries/abnormalities , Embolization, Therapeutic , Pregnancy Complications/therapy , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Adult , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnostic imaging , Bronchial Arteries/diagnostic imaging , Female , Hemoptysis/etiology , Humans , Pregnancy , Radiography , Recurrence , Telangiectasia, Hereditary Hemorrhagic/complicationsABSTRACT
Since 1830, more than eighty cases of spinal cord abscesses have been reported. In half of these cases, it was unfortunately a post-mortem diagnosis. Magnetic resonance imaging (MRI) now gives new possibilities in the diagnosis and treatment of this rare pathology. We report here a case of cervical spinal cord abscess due to Streptococcus milleri. The clinical and laboratory findings, the MRI features, the pathogenicity of the offending pathogen and the surgical approach are discussed and compared with the data from the literature. The functional course was unexpectedly favourable in this patient. MRI allows prompt diagnosis and a precise localisation of the suspected abscess. Rapid surgical drainage is a critical prognostic factor for effective management of spinal cord abscess.