Antineoplastics
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Reactions 1159 - 7 Jul 2007 S Antineoplastics Pulmonary arteriovenous communications within pulmonary metastases: 2 case reports Two women developed pulmonary arteriovenous communications within pulmonary metastases during treatment with antineoplastics. A 73-year-old woman presented with a 3-month history of progressive dyspnoea that was not relieved by supplemental oxygen via nasal cannula; about 12 months earlier, she had experienced several episodes of haemoptysis. She had undergone radical nephrectomy 12 years before presentation for renal cancer and, 2 years later, had developed multiple pulmonary metastases. She had received fluorouracil, interferon-α, capecitabine and gemcitabine [dosages not stated], after which her metastases has initially decreased in size, but later had shown progressive enlargement. At presentation, she was receiving maintenance low-dose interferon-α and floxuridine [dosages not stated]. She had a mild tachycardia, a low arterial oxygen saturation (91%) and increased levels of haemoglobin (16.6 g/dL), haematocrit (49.9) and erythropoietin (83.4 mIU/mL). A contrast-enhanced CT pulmonary angiogram showed marked enhancement within the pulmonary nodules; many of the nodules were closely related to pulmonary vessels. Her left ventricular ejection fraction was 70%. A right heart catheterisation showed decreased mixed venous oxygen saturation (70%). Arteriovenous shunting within the pulmonary metastases was postulated. Pulmonary angiography revealed high-flow arteriovenous shunting within her largest pulmonary masses; a lesser degree of shunting was observed within the smaller nodules. She underwent coil embolisation on the largest lesion in her infrahilar region and her arterial oxygen saturation immediately increased to the mid-90%. Her symptoms subsequently improved and she did not require supplemental oxygen. A 47-year-old woman, who had metastatic uterine leiomyosarcoma with pulmonary metastases, received six cycles of docetaxel and gemcitabine [dosages not stated]. During re-evaluation, a thoracic CT scan showed a decrease in size of many of her pulmonary metastases; however, an increased contrast enhancement was observed in many of her lesions along with evidence of internal necrosis and central pooling of contrast material [time to reaction onset not stated]. Reformatted images showed aneurysm and arteriovenous communication between her pulmonary arteries and veins within many of her metastases. She underwent thoracotomy and multiple right-sided pulmonary wedge resections of the metastases. Histological examination showed central necrosis and arteriovenous communications within the metastases. Pulmonary wedge resections of all of her metastases were then performed and she subsequently remained free of detectable malignancy. Bruzzi JF, et al. Development of pulmonary arteriovenous communications within pulmonary metastases after chemotherapy. Journal of Thoracic Oncology 2: 243-246, No. 3, Mar 2007 - USA 801052188 1 Reactions 7 Jul 2007 No. 1159 0114-9954/10/1159-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1159 - 7 Jul 2007
SAntineoplastics
Pulmonary arteriovenous communications withinpulmonary metastases: 2 case reports
Two women developed pulmonary arteriovenouscommunications within pulmonary metastases duringtreatment with antineoplastics.
A 73-year-old woman presented with a 3-month history ofprogressive dyspnoea that was not relieved by supplementaloxygen via nasal cannula; about 12 months earlier, she hadexperienced several episodes of haemoptysis. She hadundergone radical nephrectomy 12 years before presentationfor renal cancer and, 2 years later, had developed multiplepulmonary metastases. She had received fluorouracil,interferon-α, capecitabine and gemcitabine [dosages notstated], after which her metastases has initially decreased insize, but later had shown progressive enlargement. Atpresentation, she was receiving maintenance low-doseinterferon-α and floxuridine [dosages not stated]. She had amild tachycardia, a low arterial oxygen saturation (91%) andincreased levels of haemoglobin (16.6 g/dL), haematocrit(49.9) and erythropoietin (83.4 mIU/mL). A contrast-enhancedCT pulmonary angiogram showed marked enhancementwithin the pulmonary nodules; many of the nodules wereclosely related to pulmonary vessels. Her left ventricularejection fraction was 70%. A right heart catheterisationshowed decreased mixed venous oxygen saturation (70%).Arteriovenous shunting within the pulmonary metastases waspostulated. Pulmonary angiography revealed high-flowarteriovenous shunting within her largest pulmonary masses;a lesser degree of shunting was observed within the smallernodules. She underwent coil embolisation on the largest lesionin her infrahilar region and her arterial oxygen saturationimmediately increased to the mid-90%. Her symptomssubsequently improved and she did not require supplementaloxygen.
A 47-year-old woman, who had metastatic uterineleiomyosarcoma with pulmonary metastases, received sixcycles of docetaxel and gemcitabine [dosages not stated].During re-evaluation, a thoracic CT scan showed a decrease insize of many of her pulmonary metastases; however, anincreased contrast enhancement was observed in many of herlesions along with evidence of internal necrosis and centralpooling of contrast material [time to reaction onset not stated].Reformatted images showed aneurysm and arteriovenouscommunication between her pulmonary arteries and veinswithin many of her metastases. She underwent thoracotomyand multiple right-sided pulmonary wedge resections of themetastases. Histological examination showed central necrosisand arteriovenous communications within the metastases.Pulmonary wedge resections of all of her metastases were thenperformed and she subsequently remained free of detectablemalignancy.Bruzzi JF, et al. Development of pulmonary arteriovenous communications withinpulmonary metastases after chemotherapy. Journal of Thoracic Oncology 2:243-246, No. 3, Mar 2007 - USA 801052188
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Reactions 7 Jul 2007 No. 11590114-9954/10/1159-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
