2 CASE DESCRIPTION
A 15-year-old boy presented with recurrent onset dizziness, blurred
vision in both eyes and bilateral limbs weakness for 2 years. During the
attack, he could not stand and fainted onto the ground, then recovered
spontaneously about 5min later, no nausea, no vomiting, no tinnitus, no
hearing loss, no convulsion, and no a history of epilepsia. There were a
total of 3 times of attacks with each interval of 6 months to 1 year,
and the latest attack was 1 month before admitted to hospital. He was
admitted to our hospital on September 02, 2020. Physical examination
showed no cardiorespiratory abnormalities. The subsequent chest x-ray
showed a mass shadow in the right upper lung(Figure 1A). The cardiac
color ultrasound showed no obvious abnormalities, and no patent foramen
ovale was seen. Brain magnetic resonance imaging (MRI) and cerebral
arteries magnetic resonance angiography (MRA) showed no obvious
abnormalities. The contrast-enhanced transcranial doppler (c-TCD)
revealed a positive result with a large right-to-left shunt. The
cardiovascular CT angiography (CTA) showed the right upper pulmonary
artery expanded with a diameter of 7.4mm, its
branching vessels thickened and
twisted into an abnormal vascular nest, then directly refluxed into the
right upper pulmonary posterior vein, finaly merged into the right upper
pulmonary vein(Figure 1B,1C, and1D). Blood routine test, blood gas
analysis and coagulation test were normal. TIA induced by PAVF was
considered. The patient underwent embolization therapy of PAVF under
general anesthesia on the third day of hospitalization. Intraoperative
angiography showed a PAVF originated from the right upper pulmonary
branch artery (Figure 2A and 2B), which could not be revealed after
embolization by a vascular plug (Figure 2C and 2D). At 1 year and 2 year
postoperative follow-up, the patient remains clinical stable, no any
symptom of dizziness, blurred vision or poor lower limbs movement.