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Arteriovenous Malformations and Systemic Lung Supply

Evaluation by Multidetector CT and Three-Dimensional Volume Rendering

Leo P. Lawler1 and Elliot K. Fishman

1 Both authors: Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.



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  		Fig. 1A. —54-year-old man referred for evaluation of tubular density on chest radiograph. Conventional angiography was performed after chest radiography and conventional axial CT (not shown) when patient initially presented. Angiogram in anteroposterior view (A) shows large feeding vessel (arrow) arising from celiac axis and coursing cephalad above left hemidiaphragm to lingula. Delayed, subtracted, conventional angiogram in anterior view (B) shows large lingula vascular malformation (V) with drainage cephalad to left pulmonary artery (arrow). Conventional angiogram (C) shows injection of left bronchial artery (solid arrow), which feeds vascular malformation (open arrow) in lower left thorax.

 


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  		Fig. 1B. —54-year-old man referred for evaluation of tubular density on chest radiograph. Conventional angiography was performed after chest radiography and conventional axial CT (not shown) when patient initially presented. Angiogram in anteroposterior view (A) shows large feeding vessel (arrow) arising from celiac axis and coursing cephalad above left hemidiaphragm to lingula. Delayed, subtracted, conventional angiogram in anterior view (B) shows large lingula vascular malformation (V) with drainage cephalad to left pulmonary artery (arrow). Conventional angiogram (C) shows injection of left bronchial artery (solid arrow), which feeds vascular malformation (open arrow) in lower left thorax.

 


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  		Fig. 1C. —54-year-old man referred for evaluation of tubular density on chest radiograph. Conventional angiography was performed after chest radiography and conventional axial CT (not shown) when patient initially presented. Angiogram in anteroposterior view (A) shows large feeding vessel (arrow) arising from celiac axis and coursing cephalad above left hemidiaphragm to lingula. Delayed, subtracted, conventional angiogram in anterior view (B) shows large lingula vascular malformation (V) with drainage cephalad to left pulmonary artery (arrow). Conventional angiogram (C) shows injection of left bronchial artery (solid arrow), which feeds vascular malformation (open arrow) in lower left thorax.

 


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  		Fig. 1D. —54-year-old man referred for evaluation of tubular density on chest radiograph. Three-dimensional volume-rendered CT was performed 7 years after angiography in A-C. Left lateral oblique CT of thorax (D) shows lingular vascular malformation (a) that drains by straight small vessel (open arrow) to left superior pulmonary vein (curved arrow) and by larger parallel vessel (arrowhead) to left pulmonary artery (straight solid arrow). Superior view CT of lower thorax and upper abdomen (E) shows large tortuous feeding systemic artery (thick white arrow) in left upper abdomen arising from celiac axis (black arrow) and feeding vascular malformation in lingula (thin white arrow). Left lateral CT of thorax (F) shows second posterior chest wall vascular malformation (a) fed by two small intercostal arteries (small black arrows) and one large intercostal artery (long thin black arrow) from descending thoracic aorta. Single straight vessel (white arrows) drains to left lower lobe pulmonary artery (open arrow).

 


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  		Fig. 1E. —54-year-old man referred for evaluation of tubular density on chest radiograph. Three-dimensional volume-rendered CT was performed 7 years after angiography in A-C. Left lateral oblique CT of thorax (D) shows lingular vascular malformation (a) that drains by straight small vessel (open arrow) to left superior pulmonary vein (curved arrow) and by larger parallel vessel (arrowhead) to left pulmonary artery (straight solid arrow). Superior view CT of lower thorax and upper abdomen (E) shows large tortuous feeding systemic artery (thick white arrow) in left upper abdomen arising from celiac axis (black arrow) and feeding vascular malformation in lingula (thin white arrow). Left lateral CT of thorax (F) shows second posterior chest wall vascular malformation (a) fed by two small intercostal arteries (small black arrows) and one large intercostal artery (long thin black arrow) from descending thoracic aorta. Single straight vessel (white arrows) drains to left lower lobe pulmonary artery (open arrow).

 


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  		Fig. 1F. —54-year-old man referred for evaluation of tubular density on chest radiograph. Three-dimensional volume-rendered CT was performed 7 years after angiography in A-C. Left lateral oblique CT of thorax (D) shows lingular vascular malformation (a) that drains by straight small vessel (open arrow) to left superior pulmonary vein (curved arrow) and by larger parallel vessel (arrowhead) to left pulmonary artery (straight solid arrow). Superior view CT of lower thorax and upper abdomen (E) shows large tortuous feeding systemic artery (thick white arrow) in left upper abdomen arising from celiac axis (black arrow) and feeding vascular malformation in lingula (thin white arrow). Left lateral CT of thorax (F) shows second posterior chest wall vascular malformation (a) fed by two small intercostal arteries (small black arrows) and one large intercostal artery (long thin black arrow) from descending thoracic aorta. Single straight vessel (white arrows) drains to left lower lobe pulmonary artery (open arrow).

 

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