SYSTEMIC-TO-PULMONARY VASCULAR MALFORMATION OF LUNG VISUALIZED BY COMPUTER-ASSISTED 3-D RECONSTRUCTION

Aims: While a growing number of cases with pulmonary arteriovenous mal formation (PAVM) have been reported, detailed analysis has yet to be f ound on the relation of abnormal vessels with the whale lung vasculatu re and airways, To gain more insight into the structure-function inter relation of this disease, we attempted to visualize the vessels in and around the arteriovenous malformation, resorting to computer-aided 3- D reconstruction. Methods and results: The material was the upper lobe of the right lung from a 44-year-old man resected for recurrent haemo ptysis, On pre-surgical selective angiography, an arteriovenous commun ication was suggested to exist between a tributary of the right 3rd in tercostal artery and pulmonary vein, Semi-serial sections were prepare d from the material and submitted to 3-D reconstruction of blood vesse ls and airways, In 3-D images, branches of the 3rd intercostal artery proved to be forming a plexus of abnormally dilated, thin-walled vesse ls in the subepithelial layer of a membranous bronchiole, a situation clearly explaining the mechanism of haemoptysis, There was no capillar y bed interventing between the afferent arteries and draining vessels leading to the pulmonary vein. Conclusions: This presents the first ov erall visualization of PAVM, allowing comparison of 2-D microscopy wit h the corresponding 3-D morphology.