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J Thorac Cardiovasc Surg 2004;128:780-782
© 2004 The American Association for Thoracic Surgery

Brief communication

Tracheal obstruction from mediastinal arteriovenous malformation

^a Division of General Thoracic Surgery, Massachusetts General Hospital, Boston, Mass, USA
^b Division of Vascular Radiology, Massachusetts General Hospital, Boston, Mass, USA
^c Department of Surgery, Harvard Medical School, Boston, Mass, USA
^d Department of Radiology, Harvard Medical School, Boston, Mass, USA

Received for publication October 6, 2003; accepted for publication March 4, 2004.

^* Address for reprints: Hermes C. Grillo, MD, Massachusetts General Hospital, Blake 1570, 55 Fruit St, Boston, MA 02114, USA
pguerriero@partners.org

The first 20% of the full text of this article appears below.

Vascular malformations that appear as mediastinal masses are extremely uncommon.^1-3 In highly unusual instances, a major mediastinal arteriovenous malformation (AVM) may extend into the trachea as an obstructive mass. These lesions are developmental anomalies that are distinct from mediastinal or tracheal hemangiomas.⁴ They do not exhibit endothelial cell proliferation as hemangiomas do, nor do they regress with age.

Clinical summaries

Patient 1
A 25-year-old man had undergone right upper and middle lobectomies at age 4.5 years for "multiple hemangiomas," with residual disease that encroached on the superior vena cava. He reported progressive dyspnea on exertion, increasing fatigue, cough productive of mucus, and three episodes of pneumonia, but no hemoptysis.

Chest radiographs showed clear lungs and a mediastinal mass projecting to the right. Bronchoscopy revealed an obstructing lesion 7.5 cm below the cricoid, composed of large pulsating vessels. Biopsy was inadvisable. Diagnostic angiography through the femoral artery revealed a huge vascular malformation (Figure 1). In five separate sessions, major arterial branches arising from the internal thoracic, thyrocervical, bronchial, inferior phrenic, and right coronary arteries were embolized with balloons and . . . [Full Text of this Article]