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2016, vol. 73, br. 10, str. 956-960
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Nasledna hemoragijska teleangiektazija sa obostranim plućnim vaskularnim malformacijama
Hereditary hemorrhagic telangiectasia with bilateral pulmonary vascular malformations: A case report
aVojnomedicinska akademija, Klinika za pulmologiju, Beograd bVojnomedicinska akademija, Institut za radiologiju, Beograd cVojnomedicinska akademija, Klinika za pulmologiju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd dKlinički centar Kragujevac, Klinika za pulmologiju
e-adresa: olja.loncarevic@gmail.com
Sažetak
Uvod. Hereditarna hemoragijska teleangiektazija (HHT) ili Osler-Weber-Rendu sindrom je autozomno dominantno oboljenje nastalo usled vaskularne displazije povezane sa poremećajem u signalnom putu transformišućeg faktora rasta β (TGF β). Klinička posledica jeste poremećaj krvnih sudova u više organa, sa postojanjem teleangiektazija koje uzrokuju dilataciju kapilara i vena. Promene su prisutne od samog rođenja i lokalizovane su po koži i mukozi usne duplje, respiratornog, gastrointestinalnog i urinarnog trakta; mogu napraviti rupture sa posledičnim ozbiljnim krvarenjem koje se može završiti i smrtnim ishodom. Kako postoji poremećaj na krvnim sudovima više organskih sistema, postavljanje dijagnoze je veoma kompleksno i zahteva multidisciplinarni pristup. Prikaz bolesnika. Prikazali smo 40-godišnju bolesnicu sa dugogodišnjom evolucijom tegoba, dijagnostikovanu i lečenu u Klinici za pulmologiju Vojnomedicinske akademije u Beogradu, zbog bilateralnih plućnih arteriovenskih malformacija udruženih sa HHT. Urađena je embolizacija u dva akta, nakon čega je došlo do normalizacije kliničkog, radiološkog i funkcijskog nalaza, uz prestanak hemoptizija, intolerancije na napor i uz značajno poboljšanje kvaliteta života. Zaključak. HHT je retka, dominantno nasledna multisistemska bolest, koja zahteva multidisciplinarni pristup u dijagnostici i lečenju. Embolizacija je metoda izbora u lečenju arteriovenskih malformacija u plućima, sa neznatnim neželjenim efektima i veoma zadovoljavajućim terapijskim ishodom.
Abstract
Introduction. Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is an autosomal dominant disease that occurs due to vascular dysplasia associated with the disorder in the signaling pathway of transforming growth factor β (TGF-β). The clinical consequence is a disorder of blood vessels in multiple organ systems with the existence of telangiectasia which causes dilation of capillaries and veins, are present from birth and are localized on the skin and mucosa of the mouth, respiratory, gastrointestinal and urinary tract. They can make a rupture with consequent serious bleeding that can end up with fatal outcome. Since there is a disruption of blood vessels of more than one organic system, the diagnosis is very complex and requires a multidisciplinary approach. Case report. We reported a 40-year-old female patient with a long-time evolution of problems, who was diagnosed and treated at the Clinic for Lung Diseases of the Military Medical Academy in Belgrade, Serbia, because of bilaterally pulmonary arteriovenous malformations associated with HHT. Embolization was performed in two acts, followed with normalization of clinical, radiological and functional findings with the cessation of hemoptysis, effort intolerance with a significant improvement of the quality of life. Conclusion. HHT is a rare dominant inherited multisystem disease that requires multidisciplinary approach to diagnosis and treatment. Embolization is the method of choice in the treatment of arteriovenous malformations with minor adverse effects and very satisfying therapeutic effect.
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