A case of AVM(Arteriovenous Malformation) harboring a large venous aneurysm is presented. The AVM was located in right temporo-parietal area. The pathology revealed a AVM and large venous aneurysm which was attached to nidus and drained into petrosal sinus. The authors reviewed the pathology of AVM and venous aneurysm.
Aneurysm* ; Arteriovenous Malformations* ; Pathology

Arteriovenous malformation of the gut is well known to have been an important bleeding focus in past ages. We report a young Korean male patient, who had been known to have ventricular septal defect, presenting massive lower gastrointestinal bleeding from an arteriovenous malformation involving a long segment of the left colon. Angiographic, gross and histologic findings are presented and the literature is reviewed.
Adult ; Arteriovenous Malformations/pathology ; Arteriovenous Malformations/complications* ; Colon/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Heart Septal Defects, Ventricular/complications* ; Human ; Male

PURPOSE: To characterize the MR findings for a differential diagnosis and to make a plan for treatment by interventional technique of the vascular masses with/without hypertrophic feeding vessels of the head and neck. SUBJCETS AND METHODS: Seven patients with vascular masses of the head and neck proved by pathology, angiography, clinical findings were included. Vascular masses included 4 venous malformations, a capillary hemangioma, and a hemangiopericytoma, a hemangioma combined with arteriovenous malformation. 7 patients had MR studies with 1.0T and 1.5T using routine TI-, T2- weighted spin echo sequences, and contrast enhancement. 4 MR angiography, 3 inversion recovery, and 6 contrast angiography were studied from 7 patients RESULTS: All vascular masses demonstrated higher than muscle signal intensity on Tl-weighted images, bright signal intensity on T2-weighted images, and prominent enhancement, except AV hemangioma combined with prominent arteriovenous malformation on postcontrast scan. Three hemangiomas demonstrated distinct serpiginous signal voids. Venous malformations demonstrated venous lakes seen as homogenous regions of high signal intensity and phleboliths seen as low signal foci on images. Inversion recovery was the best pulse sequence for evaluation of the extent of lesion. CONCLUSION: MR findings of the vascular masses of the head and neck are useful in delineating the extent of the disease, differentiating venous malformation or cavernous hemangioma from other hemangiomatous lesions including hypertrophic feeding vessels, and making a plan for treatment by interventional technique also.
Angiography ; Arteriovenous Malformations ; Diagnosis, Differential* ; Head* ; Hemangioma ; Hemangioma, Capillary ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Lakes ; Neck* ; Pathology

Intracranial arteriovenous malformation is rarely presented in newborns or infants. We describe an unusual case of congenital arteriovenous malformation of the brain with multiple sequestered grape-like venous sacs presented with congenital hydrocephalus. This 4-month-old girl born with a large head, presented with progressive hydrocephalus over a period of 4 months. The brain CT showed multiloculated cysts with a high-density mural nodule and thin cerebral mantle. The right lateral ventricle was collapsed by the cystic lesion, and the contralateral ventricle was markedly dilated, which was thought to be due to aqueductal obstruction by the conglomerated nidus of the arteriovenous malformation. Surgical removal of both hemispheric masses, including the overlying thin mantle. The lesion was pathologically confirmed as the arteriovenous malformation which was composed of markedly dilated veins and multiple sequestered aneurysmal sacs. The overlying cerebral tissue was dysplastic and partly infarcted. This case shows that intracerebral arteriovenous malformation is indeed a congenital anomaly and suggests that intrauterine vascular compromise can result in focal or wide maldevelopment of the brain.
Female ; Humans ; Hydrocephalus/*etiology ; Infant ; Intracranial Arteriovenous Malformations/*complications/pathology/radiography ; Tomography, X-Ray Computed

Ultrasound is used in the diagnosis, treatment and follow-up of cerebral arteriovenous malformation (AVM). Several parameters including flow velocity, flow volume, resistance index, pulsatility index, vasomotor reactivity and their influencing factors are reviewed. The applications of ultrasound in the preoperative evaluation, intraoperative monitor and postoperative follow-up of AVM, are summarized. Although some limits exist, ultrasound can provide more reliable information about AVM, if lesions are classified according to their characteristics, compared in different conditions between preoperation and postoperation, feeding and non-feeding side, patients and healthy adults, and if ultrasound method is combined with other examinations and different developed ultrasound techniques. With the appearance and development of new ultrasound technique, its application will be wider in management of AVM.
Humans ; Intracranial Arteriovenous Malformations ; diagnostic imaging ; pathology ; Ultrasonography, Doppler, Transcranial ; methods

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoy's lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoy's lesion presenting as a mass and short segment stricture on CT and enteroclysis.
Adult ; Arteriovenous Malformations/*pathology ; Diagnosis, Differential ; Gastrointestinal Hemorrhage/*pathology ; Humans ; Jejunal Diseases/*pathology ; Jejunum/blood supply/pathology ; Male

Arteriovenous Malformations ; pathology ; therapy ; Brain Diseases ; pathology ; therapy ; Embolization, Therapeutic ; methods ; Humans ; Polyvinyls ; therapeutic use ; Treatment Outcome

BACKGROUNDThe precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations (AVMs) remain unclear. Osteopontin (OPN) is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs.

METHODSThe AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance (ANOVA).

RESULTSWe analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens (25.76 ± 2.71 vs. 21.46 ± 2.01, P < 0.01). There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage (26.13 ± 2.45 vs. 25.34 ± 2.99) or gamma knife radiotherapy (24.39 ± 2.10 vs. 24.53 ± 1.85). However, the difference between the AVM group with and that without embolization treatment history was statistically significant (24.39 ± 2.10 vs. 28.80 ± 1.13, P < 0.01). In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect.

CONCLUSIONSOPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.

Analysis of Variance ; Brain ; metabolism ; pathology ; Immunohistochemistry ; Intracranial Arteriovenous Malformations ; genetics ; metabolism ; pathology ; Osteopontin ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction

In order to obtain more accurate pathological diagosis of the angiographically occult vascular malformations(AOVM) of the brain in the future and to examine the clinical, and radiological characteristics and management outcome of the AOVM, the authors retrospectively reviewed the 30 cases of AOVM in which patients were treated at our instituition during the past 11-year period. The pathological specimens were reexamined, and the lesions were reclassified according to the strict histopathological criteria. The clinical characteristics, radiological features, the difference between the clinical and pathological diagnosis and the management results were studied. There were 15 males and 15 females. The mean age at the time of diagnosis was 31 years, ranging from 3 months to 74 years. The clinical diagnosis were arteriovenous malformation(AVM) in 18 cases, cavernous angioma in 11 and mixed lesion in 1. The pathologic diagnosis was AVM in 14 cases, cavernous angioma in 2, and unclassified lesion in 12. The common presenting symptoms were hemorrhage(53.3%), seizure(20.0%) and mass lesions(20.0%). Twenty four lesions were located at the supratentorial region, 4 at cerebellum and 2 at pons. Most of the lesions were revealed as high density masses with minimal or no contrast enhancement on CT and a core of mixed signal intensity with a peripheral low signal intensity rim on T2-weight MRI. Preoperative clinically significant recurrent hemorrhages were noted in 8 cases and one of them showed marked deterioration of the neurological functions a result of recurrent hemorrhage. Twenty-eight patients underwent surgery and all except one improved neurologically. Six patients initially presented with seizure showed improvement in seizure frequency after operation. One patient who had the lesion at the pons was managed by a radiosurgery and one patient who refused surgery was managed by a conservative method. The conservatively managed patient and another patient who was not found AVM at the hematoma cavity during initial operation rebled about 2 years later following diagnosis and surgery. Thse findings suggest that the complete microsurgical excision, which prevents rebleeding and suppresses seizure activity, represents the treatment of choice for patients with clinically symptomatic AOVM. Avoiding the injury of the vascular mass, obtaining sufficient biopsy specimen during surgery, together with careful histopathological observation of operative specimens through complete clinical-radiological-pathological context are necessary to obtain more accurate pathological diagnosis.
Arteriovenous Malformations ; Biopsy ; Brain ; Cerebellum ; Diagnosis ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pathology ; Pons ; Radiosurgery ; Retrospective Studies ; Seizures ; Vascular Malformations*

Animals ; Arteriovenous Malformations ; complications ; Child, Preschool ; Diaphragm ; blood supply ; Hemothorax ; etiology ; Humans ; Male ; Nematode Infections ; pathology ; Pleural Effusion ; etiology