Hereditary hemorrhagic telangiectasia with respiratory symptoms at the
first stage: two cases report and literature review
Abstract
Objectives: To summarize the clinical features of patients with
hereditary hemorrhagic telangiectasia(HHT) to provide a scientific
diagnosis and reduce misdiagnosis for patients with respiratory symptoms
of complication of HHT and reduce misdiagnosis. Methods:Retrospective
analysis of diagnosis and treatment of two patients with HHT in Xiangya
Hospital of Pediatrics and to summarize domestic and international
coverage of clinical characteristics of patients with respiratory
symptoms of HHT in recent years. Results:patients with HHT have these
symptoms: 31 patients Respiratory symptoms of dyspnea (48.43%), 8
patients shortness (12.50%), 9 patients chest pain (14.06%), 4
patients distress (6.25%), 4 patients chronic cough (6.25%), 15
patients cyanosis (23.43%),12 patients hemoptysis (18.75%), 6 patients
of other gastrointestinal symptoms (9.37%). The main complications were
pulmonary hypertension 16 (25.00%) and cardiac dysfunction 12
(18.75%).The majority of the involved organs were pulmonary
arteriovenous malformation (PAVMs) (60.93%). Computed tomography (CT)
scans and contrast echocardiography, CT angiography can be used for
detection ,which contrast echocardiography is preferred screening
methods for PAVMs. The therapy to deal with the symptoms and
complications mainly for vascular organ involvement, the principal means
for the diagnosis and treatment of mobilization and drug symptomatic
treatment, and liver or lung transplant is better. Conclusion The common
clinical symptoms of HHT patients with respiratory system involvement
are not typical and they are easy to lose early diagnosis. When patients
present with respiratory symptoms, the risk of developing severe
complications such as pulmonary hypertension and cardiac insufficiency
increases. Interventional mobilization is the most effective treatment
for PAVMs in HHT patients, but recurrence is possible. Transplantation
provides new hope for patients who have failed interventional therapy.