A case report of arteriovenous fistula and myasthenia gravis

مقدمه: Myasthenia gravis (MG) is a chronic autoimmune disease that mainly involves acetylcholine receptors (AChR) on the postsynaptic membrane at the neuromuscular junction, and is mainly mediated by AChR antibodies, cellular immunity, and complement. The main clinical manifestation is local or systemic skeletal MG, which usually worsens after exercise and alleviates after rest or treatment with cholinesterase inhibitors.Arteriovenous malformations (AVMs) refer to arteries and veins with abnormal connections between them.In the presence of an AVM, the arteries and veins are directly connected without intervening capillaries, reducing gas exchange and causing decreased oxygen levels and shortness of breath, especially with exertion.هدف: we decided to report A ۳۵ year old woman with a history of myasthenia gravis disease and pulmonary arteriovenous fistulaمعرفی بیمار: A ۳۵-year-old woman with a history of myasthenia gravis disease was admitted to our hospital because of fatigue and dyspnea. The patient was in her usual health state until the day of admission when she experienced shortness of breath and fatigue. On the same day, she came to the emergency department of our hospital for evaluation.The patient was diagnosed with myasthenia gravis ten years before, was on treatment with pyridostigmine and corticosteroid for the past nine years, and the disease had a progressive course. On examination, the patient was alert and fully oriented. The temperature was ۳۶.۷°C, the blood pressure ۱۰۸/۶۸ mm Hg, the pulse ۹۰ beats per minute, the respiratory rate ۱۸ breaths per minute, and the oxygen saturation ۹۸% while she was breathing ambient air. The auscultation of the lungs and heart was normal. There was no telangiectasia detected on the skin or mucosa. She declared no experience of epistaxis in recent years. The electrocardiogram and echocardiographic examination were normal.He was referred for radiological examination, and a computed tomography scan was taken that showed a roughly round opacity in the left upper lobe. Pulmonary function tests were within normal limits. We suspected the patient to have a pulmonary arteriovenous fistula.The patient underwent angiographic evaluation, and the diagnosis was confirmed. We observed a single feeding artery originating from the pulmonary artery and a single draining vein connected to the pulmonary vein in the lobulated vascular malformation during angiographyour patient was ۳۵ years lady with DOE and lung mass , with final diagnosis of lt. side lung AVM that we embolized successfully with RUBBY COIL ۸/۶۰ & good final result

کلیدواژه ها:

Myasthenia gravis ، Arteriovenous malformations ، pulmonary arteriovenous fistula