Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings

摘要

Hepatic arteriovenous malformations are rare congenital lesions associated with significant morbidity and mortality, most commonly from high output cardiac failure. Efficient diagnosis and treatment demands an interdisciplinary approach, and the interventional radiologist plays a pivotal role in both. Imaging is important for diagnostic accuracy and treatment planning, and transcatheter embolization has become an established primary therapy. We report the clinical and imaging findings of a rare hepatic arteriovenous malformation in an infant presenting with high-output cardiac failure and pulmonary artery hypertension that was successfully treated by transarterial embolization using Onyx. Keywords: Arteriovenous malformation, vascular malformation, liver, embolization, Onyx, interventional radiologyCASE REPORTA term male infant was delivered by a 20-year-old woman following an uncomplicated pregnancy. Shortly after delivery, the infant developed tachypnea, pallor, and poor muscular tone. A harsh systolic murmur was detected on physical exam and oxygen saturation was 74%. The patient required emergent intubation.Imaging findingsProfound cardiomegaly and trace bilateral pleural effusions were seen by chest radiography (Fig. 1). Echocardiogram revealed severe right heart dysfunction with atrial septal bowing, marked right atrial enlargement, and paradoxical flow across a patent foramen ovale (Fig. 2). A patent ductus arteriosus with right to left flow and 10 mmHg gradient indicative of pulmonary arterial hypertension was also identified (Fig. 3). Right ventricular function was moderately decreased, but left ventricular function was preserved. A vascular lesion was incidentally found in the liver. Open in a separate windowFigure 1 Conventional radiography.Male newborn with hepatic AVM.FINDINGS: Marked cardiomegaly and trace pleural effusions (arrows).TECHNIQUE: Portable AP chest radiograph. Shimadzu MobileDaRt Evolution.61 kVp. 1 mAs. 40 inches from patient.