Arteriovenous malformation of the base lingua in pregnancy: case report

Arteriovenous malformation (AVM) of the head and neck is a rare vascular anomaly but when present is persistent and progressive in nature and can represent itself truly as a lethal benign disease. We present here an unusual case of an AVM of the base lingua in a 32year old primigravida at 23.2 weeks of gestation with an history of hemoptysis. The patient was admitted to hospital with 10.7 g/dl of Hemoglobin and 32.1% of hematocrit but due to recurrent massive hemoptysis in the days after dropped to 6.7 g/dl of Hemoglobin and 20.2% of hematocrit which required immediate blood transfusions. To maintain upper airways the patient underwent tracheostomy; during angiography, showing a AVM with its feeding arteries (lingual artery, internal maxillary artery, and maxillary artery) an embolization without a significative blood flow reduction was made. After surgical ligation of the external carotid artery of the right side the woman was readmitted for a further angiographic evaluation, which confirmed the complete occlusion of the carotid artery but in the same time showed the integrity of the AVM perfusion because of a new feeding artery (left lingual artery). A new superselective catheterization of the lingual artery was made but due to the effect of progesterone, which causes smooth muscle relaxation and leads to AVM dilatation and its rupture the primigravida presented new hemoptysis. According to gynaecologists the patient was given betamethasone to speed fetal lung maturation, and the induction of labor was planned at 26 weeks, and a healthy baby was delivered vaginally. During the following days the patient had no further hemoptysis and up to now clinical examination showed no evidence of the original mass (slight haemorrhagic suffusion of the right anterior amygdale region).