PMC9899467_01
MR diffusion-weighted imaging showing a vague left ischemic lesion and a small right lesion (a), perfusion imaging showing diffuse left hypoperfusion (b), and MR angiography showing left middle cerebral artery occlusion (arrow) (c). Chest CT showing a pulmonary arteriovenous malformation in the left lung (arrowheads) (d).
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F1
MRI diffusion-weighted imaging (DWI) showed a vague high-signal area in the left lenticular nucleus and corona radiata, and a small clear lesion in the temporal lobe, with a DWI-Alberta Stroke Program Early Computed Tomography (CT) Score of 9/11 [Figure 1a]. MRI fluid-attenuated inversion recovery showed a left hyperintense MCA sign, perfusion-weighted image showed diffuse left hypoperfusion [Figure 1b], and magnetic resonance angiography (MRA) showed occlusion of the distal M1 segment of the left MCA [Figure 1c]; however, neck MRA showed no embolic source in the proximal vessels including the aortic arch. Chest CT showed a PAVM in the S10 inferior lobe of the left lung [Figure 1d].
Left internal carotid arteriography before (a and b) and after treatment (c and d). The occlusion of the left middle cerebral artery (arrows) was successfully recanalized (arrowheads). Post-treatment CT showing a contralateral intracerebral hematoma (e). Follow-up MR imaging (f) and MR angiography (g) showing no evidence of recurrent stroke.
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F2
Angiography showed occlusion of the M2 segment of the left MCA [Figures 2a and b]. AM, Thrombolysis in Cerebral Infarction 3, Figures 2c and d). Activated clotting time was 162 before treatment and 166 at the end of treatment. Head CT showed an intracerebral hematoma in the contralateral right temporal lobe, but no new abnormal findings were found on the treated side [Figure 2e]. Head MRI and MRA on day 11 showed no evidence of recurrent stroke [Figures 2f and g].
Chest CT angiography (a) and pretreatment angiography (b and c) showing a pulmonary arteriovenous malformation (PAVM) in the lower lobe of the left lung (arrows). The PAVM was embolized with a total of 10 coils (d) and shunt blood flow disappeared (e).
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F3
Chest CT angiography on day 10 confirmed the diagnosis of PAVM in the left lung S10 [Figure 3a], and the venous sac was 19 x 12 mm. The PAVM was a single lesion, simple type with a single feeder (2.6-2.8 mm in diameter), and a single drainer [Figures 3b and c]. A total of 10 coils were used and shunt blood flow disappeared [Figures 3d and e].