肺部動靜脈畸型：一病例報告

Pulmonary Arteriovenous Malformations (PAVM): A Case Report

肺部動靜脈畸型（pulmonary arteriovenous malformation）是一少見的肺部動脈與靜脈間形成異常交通的血管性疾病，好發於女性，發生率隨著年紀增長而增多。大約半數病人無症狀，有些病人會有胸痛、咳嗽、咳血、呼吸困難、喘等情形。胸部X光攝影檢查常呈現單一或是多發性邊緣清楚的圓形結節，病灶好發於下肺葉，會產生右向左分流（right-to-left shunt）等症狀。臨床上藉由影像學檢查如胸部X光及電腦斷層攝影懷疑肺部動靜脈畸型存在時，可進一步做血管攝影來確定診斷。在此提供一年輕男性病例，臨床上有一般呼吸道感染症狀，在診所接受藥物治療但症狀無改善。至本院經由一系列影像學檢查，發現在右下肺葉、左下肺葉及右上肺葉各有一結節病灶，最後根據血管攝影檢查確定診斷為肺部動靜脈畸型。希望藉此病例提供基層醫師，面對一咳嗽、呼吸困難甚至咳血的病人，胸部X光攝影呈現單一或是多發性結節時，應將動靜脈畸型列入考慮，給予進一步的檢查，做正確的診斷而給予適當的治療。

Pulmonary arteriovenous malformations (PAVMs) are caused by abnormal communications between pulmonary arteries and pulmonary veins. The incidence of PAVM increases with age and is most prevalent in women. Symptoms of PAVM include chest pain, cough, hemoptysis, dyspnea, and shortness of breath, but more than half of all patients with PAVM have no symptoms. Chest radiography reveals a single or multiple nodules with well-defined margins, most frequently found in the lower lung fields, causing right-to-left shunting. In clinical practice pulmonary angiography is the gold standard examination for confirming the presence of PAVM in patients in whom results were inconclusive after other tests such as chest radiography or computed tomography. Herein, we report a case of a young man who had some symptoms of a respiratory tract infection. He had gone to a general clinic for medical treatment but in vain. He then came to our hospital and underwent a series of examinations, which disclosed a solitary nodule over the right lower lobe, left lower lobe, and right upper lobe. PAVM was confirmed by pulmonary angiography. The purpose of this article is to remind primary care physicians to consider PAVM in the differential diagnosis if the patient presents with the symptoms noted above, and if chest radiography reveals solitary or multiple nodules. Treatment of patients with PAVM is most effective if diagnosed and treated early.