CASE REPORT
Arteriovenous malformation of the nasopharynx: A case report

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Summary

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 with the size of 1.5 cm × 0.8 cm at the adenoid tissue found in an 8-year-old boy, which is not previously reported in the literature where we treated the patient with surgery alone. Although bleeding is a common presentation with vascular malformations, we have not seen any bleeding in our case. After the surgery, paranasal sinus and neck CT were undertaken. They showed no other AVM.

Introduction

Various classifications of vascular lesions have been suggested. One of them is associated with three identifiable stages of vascular system differentiation: undifferentiated capillary network, retiform and vascular maturation. Developmental failure in the undifferentiated capillary stage results in capillary or cavernous hemangiomas, the retiform stage results in vascular malformations and vascular mature end stage results in port-wine stains and lymphangiomas [1]. Another classification made by Mulliken and Glovacki [2] to differ the biological behaviour of the vascular malformations. The vascular malformations can be further subdivided into capillary, venous, lymphatic, arterial or a combination of these channel types [3]. Arteriovenous malformation (AVM) is a structural vascular abnormality in which the arterial vasculature connects with the venous vasculature [4]. In addition, trauma, an ischemic event secondary to thrombosis, ectasia, hormonal changes and puberty can induce proliferation of the AVM [5]. The AVM usually involves a single vessel when caused by trauma but in congenital form, it involves multiple vessels. Vascular malformations are commonly present at birth and grow commensurably with the patient, usually not showing clinical significance until later in childhood. In general, there is no spontaneous involution. Bone involvement occurs in 35% of cases [6], [7]. AVM may present in any tissue of the body but it is more common in the head and neck region [8]. We present here an unusual case of AVM located in nasopharynx, which has not been reported before.

Section snippets

Case report

An 8-year-old boy presented with the complaints of recurrent upper respiratory infections, snoring at nights with open mouth for 3 years. He had no history of recent trauma or nasal bleeding. Nasal endoscopy with 0° endoscope revealed an adenoid hypertrophy. His laboratory tests were all normal. Adenoidectomy was performed under general anesthesia. The specimen sized 1.5 cm × 0.8 cm with pedicle was sent for biopsy as it was like a polypoid tissue, which actually presented a different form of

Discussion

Vascular lesions are seen as often as 50% in the head and neck region [9]. Most of the head and neck vascular malformations occur in the scalp and the skin [9]. In comparison with hemangiomas and the venous malformations, arteriovenous malformations of the head and neck are rare [10]. AVM can occur as an acquired event, especially following trauma, but a majority is congenital [11]. Since our patient had no known trauma, we assume that his AVM was congenital. As AVM has the gradual onset and

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