Hämoptysen in der Schwangerschaft

Zusammenfassung

Wir stellen hier eine sehr seltene, aber wichtig zu bedenkende Ursache einer pulmonalen Hämorrhagie in der Schwangerschaft vor. Eine 41-jährige Patientin stellt sich mit Hämoptysen in der 29. Schwangerschaftswoche vor, die bei Oligosymptomatik und spontanem Sistieren als unspezifisch entzündlich gedeutet werden. Bei Wiedervorstellung in der 34. Schwangerschaftswoche mit progredienter Hämoptoe sowie Schwindel erfolgt der Nachweis einer bis dahin nicht bekannten idiopathischen pulmonalen AV-Malformation, die eng interdisziplinär abgestimmt mit Bronchoskopie, Sectio caesarea, CT-Thorax und VATS/Minithorakotomie mit Segmentresektion notfallmäßig erfolgreich behandelt wird.

Abstract

Here we present an extremely rare but important cause of pulmonary hemorrhage during pregnancy. A 41-year-old patient was seen with hemoptysis in the 29th week of her pregnancy which was initially assessed as unspecific inflammation. At the 34th week of pregnancy, she presented again, this time with hemoptoe and dizziness caused by an unknown idiopathic pulmonary AV malformation. The patient underwent extensive interdisciplinary evaluation including bronchoscopy, emergency cesarean section was performed, which was followed by CT scan and VATS/minithoracotomy with segment resection.

• Literatur

• 1 Sloan RD, Cooley RN. Congenital pulmonary arteriovenous aneurysm. Am J Roentgenol Radium Ther Nucl Med 1953; 70: 183
• 2 Swanson KL, Prakash UB, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982 – 1997. Mayo Clin Proc 1999; 74: 671
• 3 Guttmacher AE, Marchuk DA, White Jr RI. Hereditary hemorrhagic teleangiectasia. N Engl J Med 1995; 333: 918
• 4 Shovlin CL, Jackson JE, Bamford KB. et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax 2008; 63: 259
• 5 Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med 1998; 158: 643
• 6 Mager JJ, Overtoom TT, Blauw H. et al. Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol 2004; 15: 451
• 7 Cottin V, Dupuis-Girod S, Lesca G. et al. Pulmonary vascular manifestations of hereditary hemorrhagic teleangiectasia (rendu-osler-disease). Respiration 2007; 74: 361
• 8 Cottin V, Chinet T, Lavole A. et al. Pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia: a series of 126 patients. Medicine (Baltimore) 2007; 86: 1
• 9 Pollak JS, Saluja S, Thabet A. et al. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol 2006; 17: 35
• 10 Wong HH, Chan RP, Klatt R. et al. Idiopathic pulmonary arteriovenous malformations: clinical and imaging characteristics. Eur Respir J 2011; 38: 368
• 11 Gershon AS, Faughnan ME, Chon KS. et al. Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations during pregnancy. Chest 2001; 119: 470
• 12 Remy J, Remy-Jardin M, Wattinne L. et al. Pulmonary arteriovenous malformations: evaluation with CT of the chest before and after treatment. Radiology 1992; 182: 809
• 13 Remy J, Remy-Jardin M, Giraud F. et al. Angioarchitecture of pulmonary arteriovenous malformations: clinical utility of three-dimensional helical CT. Radiology 1994; 191: 657
• 14 Ohno Y, Hatabu H, Takenaka D. et al. Contrast-enhanced MR perfusion imaging and MR angiography: utility for management of pulmonary arteriovenous malformations for embolotherapy. Euro J Radiol 2002; 41: 136
• 15 Faughnan ME, Palda VA, Garcia-Tsao G. et al. International guidelines for the diagnosis and management of hereditary haemorrhagic teleangiectasia. J Med Genet 2011; 48: 73
• 16 Terotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol 2010; 195: 837