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AVM Survivors Network

CT Results - Waiting for Neurology

HI all, AVM in my left neck was originally diagnosed in 1978 and has been treated in 1978, 1986 and 2009. Since 2009, my ears have been getting worse - more and more noise, distorted sound, pressure and sometimes pain. In addition, my left lung has become less functional due to the phrenic nerve being damaged and my speech and eating etc. have been impacted because the hypoglossal nerve in my left tongue has been compromised. In addition, I’m seeing increasing pain in my left arm and shoulder and tremors in both arms and hands.

My primary doctor ordered a CT scan to see if there is anything that has changed and what to do. I got this back from them and we are now waiting to hear from the Neurologist to get their opinion on it. I’m coping the whole thing below - and I’d love any insights into what you think it means. Thanks, Tom

ENCOUNTER:
Not applicable

CTA NECK FINDINGS:
Again noted are findings within the left neck and left upper chest related to a large arteriovenous malformation. There is asymmetric enlargement and architectural distortion within the left neck and upper chest related to numerous dilated vascular
structures and innumerable phleboliths. There is also redemonstration of a large peripherally calcified mass within the anterior left lower neck measuring 6.2 x 6.8 cm, not significantly changed in size from prior CTA of 9/11/2011 but now having both
peripheral and internal calcification. There are several metallic surgical clips within the left neck.
There is a left-sided, three vessel aortic arch with conventional branching anatomy. There is mild atherosclerotic plaque within the arch branch vessels. There is no flow-limiting stenosis of the innominate or subclavian arteries.
The common carotid artery origins are patent. There is no flow-limiting stenosis of the common carotid arteries. The carotid bulbs are widely patent. There is no flow-limiting stenosis of the cervical internal carotid arteries.
The vertebral arteries are relatively codominant and arise from their respective subclavian arteries. The vertebral arteries are widely patent throughout their cervical course. There are several dilated venous structures within the left vertebral
plexus, resulting in multilevel left foraminal enlargement/remodeling. These findings appear relatively similar to the prior study.
While incompletely evaluated on this exam, there is evidence of asymmetrically enlarged venous structures within the left anterior temporal lobe and along the left aspect of the brainstem, suggesting intracranial venous contribution to the patient’s
known AVM. This finding was not definitively present on prior CT angiogram of 2011 though the exam was not optimized for evaluation of the venous structures.
There is unchanged soft tissue fullness within the left-side of the oropharynx that appears to represent portions of the AVM. There is fatty atrophy within the left hemitongue. There are some atrophic changes within the left sternocleidomastoid muscle
which may be related to chronic denervation atrophy and/or postoperative change. Similar findings are noted within the left-sided paraspinal musculature. There is a multinodular thyroid gland.
Again noted is remodeling of the left jugular foramen and hypoglossal canal secondary to numerous dilated vascular structures, relatively similar to prior neck CT of 10/14/2013.

IMPRESSION:

  1. Again noted is a very large arteriovenous malformation within the left neck and upper chest, not significantly changed in extent from prior CT angiogram of 2011. The previously noted large soft tissue mass within the anterior left lower neck is also
    similar in size to the prior exam but has increased calcification.
  2. There are a few asymmetrically dilated venous structures within the left temporal lobe and coursing along the left aspect of the brainstem, a new finding from 2011 and suggesting intracranial recruitment from the AVM. The clinical significance of
    this finding in relation to the patient’s acute symptoms is uncertain and clinical correlation is necessary.
  3. Chronic denervation changes within the left hemitongue and left-sided neck musculature.

Tom,

I don’t know what it means but my reading of it is that points 2 & 3 are your main changes, i.e. your AVM has been busy “recruiting” vessels up your brainstem and into the left temporal lobe of your brain. And there is some impact on your nervous system, left side, which might be giving you the issues you’re detecting. The radiographer is reserving judgement on whether your AVM is causing all of this, especially since it is ALL left-sided. You’d perhaps expect some crossover: damage to left brain usually presents as right-side issues?

Very best wishes

Richard

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