Abstract: Arteriovenous malformations (AVM) occurring extra-cranially are rare compared to their intracranial counterpart. The potential for expansion of these AVMs throughout life with soft tissue invasion, bleeding, deformity, and functional deficits has led to much concern in terms of management. We report a case of shoulder AVM in a boy and the management dilemma it poses when he presented with multiple bleeding episodes from the ulcerated mass.
A 13-year-old boy was referred for bleeding due to an infected right shoulder ulcer for 3 years. Angiogram done previously showed a right shoulder AVM. There was no bleeding, pain or ulceration at that time. Embolization was done twice. However, he was admitted with recurrent episodes of bleeding managed by repeated embolization. We were unable to completely identify/embolise all feeding vessels to the AVM. His wound remained dirty, easily bleed during dressing change and he required repeated blood transfusions.
A multidisciplinary team was involved, including vascular surgeons, interventional radiologists, plastic surgeons, paediatric orthopaedic surgeons and an orthopaedic oncologic surgeon. Management options were discussed. It was clear that excision was not feasible as it extends to the neck region. A conservative option in the form of “embolise if bleed” seemed to be the most feasible option.
Keywords: Arteriovenous malformations; angioembolization; extra-cranial; shoulder.
Title: A Case of Extra-Cranial Shoulder Arterio-Venous Malformation And Its Management Challenge; Case Report
Author: Haj Hamad Mohammed, Azim Idris, Hanafiah Harunarrashid
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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