Incidental Thrill Detected in the Radial Artery of a Patient Who Presented with Fever

Year 2025, Volume: 13 Issue: 1, 14 - 16, 28.03.2025

Yasemin Duman , Okşan Derinöz-güleryüz , Ayla Akca Çağlar

https://doi.org/10.21765/pprjournal.1617928

Abstract

Introduction: Arteriovenous malformations (AVMs) are shunts that occur due to the absence of a capillary bed between arteries and veins. Pulsation differences, thrills, and high temperatures can be detected in the affected area due to the accumulation of arterial blood in venous vessels. They are asymptomatic in the early stages, but their growth accelerates, and they become symptomatic in cases such as pregnancy and trauma.

Case: A previously healthy 23-month-old male patient was brought to the Pediatric Emergency Department with fever, productive cough, and diarrhea complaints. The patient's vital signs were stable, no pathology was detected in the physical examination, and a thrill was detected on the left radial artery in the pulse examination. There was no color change in the extremity examination, and the capillary refill time was normal. Doppler sonography showed a "13x11 mm fusiform vascular structure with 'alising' artifact. Arterialized flow was observed in the venous structure associated with the lesion, which was compatible with the cephalic vein, and the findings were interpreted as AVM. Elective angiography was planned for the patient by the Cardiovascular Surgery Department. The patient's fever regressed during the emergency room follow-up, and the thrill disappeared in the radial artery during the follow-up physical examination. It was thought that this situation was due to the increase in thrill intensity by hyperdynamic findings such as fever increasing blood flow.

Conclusion: AVMs are rare and often asymptomatic. It is known that hyperdynamic findings such as fever can trigger the condition, and complications such as heart failure can develop in severe forms. AVMs, which are often diagnosed incidentally with imaging methods performed for different purposes, were detected incidentally with the detailed physical examination of this patient, and the importance of physical examination was emphasized in this case.

Keywords

arteriovenous malformation, thrill, radial artery, physical examination

Ateş Yakınması İle Başvuran Radial Arterde İnsidental Thrill Saptanan Hasta

Abstract

Giriş: Arteriovenöz malformasyon (AVM), arter ve venler arasındaki kapiller yatağın olmamasıyla nedeniyle oluşan şantlardır. Arteriyel kanın venöz damarlarda birikimine bağlı etkilenen bölgede pulsasyon farkı, thrill ve yüksek sıcaklık saptanabilir. Erken dönemlerde asemptomatik olup gebelik, travma gibi durumlarda büyümeleri hızlanıp semptomatik hale gelebilirler.

Olgu: Daha önce sağlıklı 23 aylık erkek hasta, ateş, balgamlı öksürük ve ishal şikayeti ile Çocuk Acil Servise getirildi. Vital bulguları stabil olan hastanın, fizik muayenesinde patoloji saptanmayan hastanın, nabız muayenesinde sol radial arter üzerinde thrill saptandı. Ekstremite muayenesinde renk değişimi yoktu, kapiller dolum zamanı normaldi. Doppler Sonografi ‘de “13x11 mm fuziform vasküler yapılanma izlenmiş 'alising' artefaktı görüldü. Sefalik ven ile uyumlu, lezyon ile ilişkili venöz yapıda arterialize akım izlenmiş olup bulgular AVM ile olrak yorumlandı. Kalp ve Damar Cerrahisi bölümünce hastaya elektif anjiografi planlandı. Acil servis takibinde ateşi gerileyen hastanın kontrol fizik muayenesinde radial arterde thrill kayboldu. Bu durumun ateş gibi hiperdinamik bulguların kan akımını artırarak thrill şiddetinde artışa bağlı olduğu düşünüldü.

Sonuç: AVM’ler nadir görülmekte olup, sıklıkla asemptomatiktir. Ateş gibi hiperdinamik bulguların durumu tetikleyebileceği, ağır formlarda ise kalp yetmezliği gibi komplikasyonlar gelişebileceği bilinmektedir. Sıklıkla farklı amaçlarla yapılan görüntüleme yöntemleri ile tesadüfen tanı alan AVM’ler, bu hastanın detaylı fizik muayenesi ile insidental olarak saptanmış olup, bu olgu ile fizik muayenenin önemi vurgulanmak istenmiştir.

Keywords

Arteriovenöz malformasyon, fizik muayene, radiyal arter, thrill

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