The Role of Interventional Radiology in the Diagnosis and Treatment of Pulmonary Arteriovenous Malformations.

Pulmonary arteriovenous malformations (PAVMs) are uncommon, predominantly congenital direct fistulous connections between the pulmonary arteries and pulmonary veins, resulting in a right to left shunt. Patients with PAVMs are usually asymptomatic with lesions detected incidentally when radiological imaging is performed for other indications. In this review, we discuss the classification and radiological features of PAVMs as well as their treatment and follow-up options, with a particular focus on percutaneous endovascular techniques and the evolution of the available equipment for treatment.

Management of an Extensive Intraparotid and Auricular Arteriovenous Malformation.

BACKGROUND Extracranial arteriovenous malformations (AVMs) of the parotid gland and auricle are rarely encountered. Management of these AVMs depends on the Schobinger stage and their flow characteristics. We present a rare case of an AVM involving the parotid and auricle concurrently. The clinical and imaging features of these high-flow vascular malformations and their treatment options are discussed and we provide a review of the literature. CASE REPORT A 40-year-old woman presented with a large 6.4×6.0×13.0 cm high-flow Schobinger stage II high-flow AVM of the parotid gland and auricle. Diagnostic imaging included magnetic resonance imaging (MRI) and conventional catheter angiogram, which defined the vascular anatomy and flow characteristics of the AVM. She was treated with preoperative endovascular embolization followed by surgical excision and free-tissue transfer reconstruction on the next day. The results were excellent, with no recurrence over 3.5 years of follow-up. CONCLUSIONS This is the second case reported in the literature of high-flow AVM concurrently involving the parotid gland and auricle, treated with perioperative embolization followed by surgical excision and grafting. Management of AVMs requires a multidisciplinary team approach and understanding of the natural history of the lesion. Although total surgical resection is the criterion standard for these AVMs, endovascular embolization is an alternative treatment that can be used as an adjunct to surgery. Furthermore, perioperative embolization can decrease the vascularity of the lesion and effectively reduce blood loss during AVM surgery.

Office 3D-printing in paediatric orthopaedics: the orthopaedic surgeon's guide.

BACKGROUND: 3D-printing, or additive manufacturing has become increasingly popular across scientific and engineering fields. The same trend has been observed in the medical field, with the main users being the dentists and the neurosurgeons. Within orthopaedic surgery, usage has been limited by accessibility and costs. The benefits of a 3D printed model in surgical planning and education in orthopaedic surgery is obvious, especially in fields like deformity correction and fracture fixation. METHODS: An in-house 3D-printing facility was set up, with workflow processes defined. We utilised the described workflow to 3D-print models for four paediatric orthopaedic patients with differing pathologies. RESULTS: These case examples show how 3D-printing of surgical models was easily performed, and they are useful in various clinical scenarios within paediatric orthopaedics. The steps involved in the process are accurately detailed, and are reproducible by any orthopaedic surgeon. The benefits of the application of 3D models in the deformity assessment and surgical planning of these cases are discussed individually. CONCLUSIONS: An in-house 3D-printing facility is useful in paediatric orthopaedics due to the variety of complex pathologies and anatomy. We have shown that it is easy to set up with a defined work process. We advocate the application of this emerging technology into every orthopaedic practice.