Mandibular arterio-venous malformation (case report)-rare life threatening condition

Abstract

Arteriovenous malformations (AVM) are defects in the vascular system, consisting of tangles of abnormal blood vessels (nidus), in which the feeding arteries are directly connected to venous drainage without the interposition of a capillary bed. AVM can occur anywhere in the body, most common in the brain. Other common locations are hepatic, musculoskeletal AVM, spinal AVM, pulmonary, and uterine AVM. In musculoskeletal soft tissue and joints are the more common sites. Bone AVM is very rare. The mean age is 21.86 years. The patient came with complaints of swelling in the left cheek with slight redness over the skin. There was no of history of pain. On examination, no pulsation present. Clinical diagnosis of parotid swelling was given. On USG- loculated cystic lesion in the left mandible with multiple locules and floating internal echoes. On color Doppler, internal vascularity was noted with in the cystic lesion. On computed tomography (CT) scan, a loculated cystic lesion in the enlarged left mandible – enhancement noted with in this cystic lesion – suggesting vascular channels in arterial and better seen in venous phase of contrast imaging. Patient was referred to interventional radiologist where the patient has undergone angioembolization of the AVM followed by mandibulectomy and artificial teeth fixation. As biopsy of the lesion would be dangerous due to significant hemorrhagic risk. Careful attention to the Doppler uptake in USG and contrast uptake in CT angiogram relative to nearby vessels, detection of nearby enlarged abnormal vessels, and performance of dynamic angiography to document arteriovenous shunting are crucial for appropriate management.

Keywords

• arteriovenous malformation/diagnosis
• auditory-verbal therapy
• dilated vascular channels in mandibular bone