Objective To investigate the clinical characteristics and treatment for Type II pulmonary vascular anomaly ( pulmonary arteriovenous malformations) of hepatopulmonary syndrome ( HPS)presenting with hemothorax. Methods A case of Type II pulmonary vascular anomaly of HPS presenting with recurrent hemothorax was described. The clinical data was analyzed and the related literature was reviewed. Results A 72-year-old male patient with Type II pulmonary vascular dilatations of HPS was described to present with recurrent dyspnea and encapsulated pleural effusions. After 4 procedures of thoracentesis, a total of 2510 mL of bloody pleural effusions was drained. The routine analysis of pleural fluid showed the count of red cells exceeded 100 ×109 / L, whereas cytologic examination and tumor biomarkers were negative. Then CTPA and pulmonary angiogramrevealed a Type II pulmonary vascular anomaly of HPS combined with hemothorax. The PaO2 of arterial blood in upright and supine position was 58. 3 mm Hg and 66. 3 mm Hg, respectively. Hypoxemia was alleviated and hemothorax was controlled after embolization of malformed blood vessels. Fromliterature review, similar cases of hemothorax resulted fromrupture of Type II pulmonary vascular anomaly of HPS were not reported. The primary clinical manifestations of HPS were dyspnea and cyanosis. Orthodeoxia and platypnea were most consistent with HPS. The best screening tool for hypoxemia in patients with HPS was P( A-a) O2. The characteristic findings of HPS on chest CT was a lesion or reticulonodular opacities occurring predominantly in the bases of the lungs, which could be enhanced by contrast medium. Pulmonary angiogram was necessary to identify the types of pulmonary vascular dilatations. Hepoxemia of patients with Type II HPS often responded poorly to oxygen therapy, whereas embolization of the pulmonary arteriovenous fistulas was helpful to improve anoxia. Conclusions Rupture ofType II pulmonary vascular malformations in HPS was a rare cause of hemothorax. Thrombosis of pulmonary arteriovenous malformations may result in significant improvement in oxygen saturations as well as control of hemothorax. In the setting of liver disease, intrapulmonary vascular dilatations and hypoxemia often suggestthe existence of HPS.
Objective To explore the application effects of coils and vascular plug in the interventional embolization treatment of simple pulmonary arteriovenous malformation (PAVM) in the Chinese real-world setting, and compare the persistent occlusion effect and cost-effectiveness of the two types of devices. Methods Simple PAVM patients who underwent interventional embolization at the Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University between January 1, 2020 and August 30, 2025 were selected retrospectively. The included patients were divided into the coil group and the vascular occlusion device/combination group according to the type of embolization instrument used in the interventional surgery. Clinical, imaging, procedural, and follow-up data were collected. The primary unit of analysis was PAVM. Primary outcome is durable occlusion rate and recanalization/persistence rate, assessed by strict imaging criteria. Intergroup comparisons, Kaplan-Meier survival analysis, and logistic regression were performed to compare treatment outcomes between coils and vascular plugs and to explore risk factors for persistence. Cost analysis was conducted to compare the cumulative cost required to achieve durable occlusion for each device. Results A total of 34 PAVM in 29 patients were included. The persistence rate was significantly lower in the vascular plug/combination group compared to the coil group (0.0% vs. 47.8%, P=0.006). The vascular plug group demonstrated higher durable occlusion rates at ≥12 months (100.0% vs. 60.9%, P=0.017), along with a significantly longer duration of sustained occlusion (P=0.008). Multivariate logistic regression analysis did not identify independent predictive factors, although the distance from the embolic device to the sac entrance showed a borderline significant association (P=0.080). The cost analysis results showed that although the surgical instrument cost, total material cost, total surgical cost of the vascular occlusion device/combination group were higher (P<0.001). There was no statistically significant difference in the cumulative total cost between the two groups (P=0.066). Conclusions For the treatment of simple PAVM, vascular plugs provide significantly superior long-term occlusion outcomes compared to coils. From a long-term perspective, the advantage of vascular plugs in reducing the need for re-intervention, their overall cost-effectiveness is expected to become more prominent, demonstrating superior value for clinical application and health economics.
