Developmental venous anomaly with an arteriovenous shunt and a thrombotic complication - Case report

Developmental venous anomalies (DVAs) are common congenital variations of n ormal venous drainage that are known for their benign natural history. Isol ated cases of symptomatic DVAs with associated arteriovenous (AV) shunts ha ve recently been reported. The present case, in which thrombosis occurred i n a DVA involving an AV shunt, raises intriguing questions regarding the cl inical characteristics of these lesions and can be used to argue in favor o f considering such lesions to be arteriovenous malformations (AVMs). A 39-year-old man presented with acute thrombosis in a complex system of an omalous hemispheric venous drainage, which included two distinct DVAs, one of which involved an AV shunt. The hemodynamic turbulences induced by a com munication between shunted and normal venous outflows were the possible pre disposing factor of the thrombosis. Follow-up angiographic and magnetic res onance images revealed complete recanalization of the thrombosed vessel and provided a thorough visualization of the particular angioarchitecture of t he DVA. Acute thrombosis within a DVA with an AV shunt has not been reported previo usly and, thus, this case can be added to other reports of complications th at arise in this particular type of DVA. The authors hypothesize that the p resence of an AV shunt in a DVA is a risk factor for aggressive clinical be havior of the anomaly, rendering those lesions prone to complications simil ar to AVMs. Although no treatment can be offered, the presence of an AV shunt in a DVA warrants close follow-up observation because such lesions may represent a p articular subtype of AVM and, therefore, may exhibit an aggressive clinical behavior.