意外发现源自膈肌的动静脉畸形:病例报告和文献综述

Cara Gose, Prakash Patel, Alexander Posch, Adam Bowling
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摘要

动静脉畸形(AVM)被定义为在没有毛细血管网的情况下,动脉和静脉之间的异常连接。本病例报告将讨论偶然发现的可能源自膈肌的动静脉畸形。一名 65 岁的女性前来进行脐疝修补术。她的既往病史包括高血压、2 型糖尿病、胃食管反流病和一级肥胖症。她曾于 2020 年接受过宫腔镜手术,1996 年接受过腹腔镜手术。她没有吸烟、酗酒或使用娱乐性药物的病史。她对造影剂过敏。她接受了计算机断层扫描(CT),结果意外发现左上腹邻近胃和膈肌的部位有一个软组织肿块,可能是胃肠道间质瘤(GIST)或脾瘤,此外还有腹壁裂伤。食管胃十二指肠镜检查(EGD)的食管、胃和十二指肠活检结果均为良性。肝脏和脾脏的核医学扫描发现,在胃底和左侧半膈之间有一个约 2.3 厘米的软组织结节,没有显示出磺胺胶体摄取,因此与脾脏不符。这是唯一一例源于膈肌的动静脉畸形。我们怀疑该 AVM 的起源是膈下动脉。对该病例的处理决定是进行腹部和胸部 CT 扫描,以追踪动静脉畸形的路径,并进行监控管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidental finding of an arteriovenous malformation originating from the diaphragm: Case report and literature review
Arteriovenous malformations (AVMs) are defined as aberrant linkages between arteries and veins in the absence of a capillary network. This case report will discuss the incidental finding of an AVM likely originating from the diaphragm. A 65-year-old female presents for an umbilical hernia repair. Her past medical history is significant for HTN, type 2 diabetes mellitus, gastroesophageal reflux disease, and class 1 obesity. She has a past surgical history of hysteroscopy in 2020 and laparoscopy in 1996. She has no history of tobacco use, alcohol use, or recreational drug use. She is allergic to contrast. A computed tomography (CT) scan was ordered and incidentally showed a soft tissue mass in the left upper quadrant adjacent to the stomach and diaphragm, possibly a gastrointestinal stromal tumor (GIST) or splenule, in addition to diastasis of the abdominal wall. Biopsies of the esophagus, stomach, and duodenum from the esophagogastroduodenoscopy (EGD) were all benign. A nuclear medicine scan of the liver and spleen found an estimated 2.3 cm soft tissue nodule located between the fundus of the stomach and the left hemidiaphragm that does not demonstrate sulfa colloid uptake and is therefore not consistent with a splenule. This is the only incidence cited of an AVM originating from the diaphragm. We suspect that the origin of this AVM is the inferior phrenic artery. The decision for management for this case was to get a CT scan of the abdomen and chest to trace the path of the AVM and manage with surveillance.
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