Giant chest wall arteriovenous malformation with spinal cord compression.

Congenital arteriovenous malformations (AVMs) may occur in any organ. Skin AVMs are common, but AVMs of the chest wall or extradural space are uncommon. We report a patient with an extensive AVM that involved skin, chest wall, and extradural space. Definitive treatment of such an AVM is difficult. A 23-year-old man presented with progressive lower extremity weakness. A large cutaneous 'haemangioma' of the right chest posterior wall measuring .22 cm in greatest diameter had been present since birth (figure 1). There was no history of ulceration, bleeding, or rapid increase in size. Underlying soft tissues of the chest wall were involved. The AVM was easily compressed and it rapidly refilled. Neurological examination showed generalised weakness of both lower extremities. The right plantar response was extensor; left plantar response was flexor. Laboratory investigations were normal. Chest radiograph showed deformity of the right 6th through 10th ribs. Chest computed tomography (CT) showed a large vascular mass involving the skin, chest wall, pleura, and posterior mediastinum of the right chest (figure 2). CT myelogram showed extension of this mass into the extradural space at the T-6 level. The neural foramen was enlarged. At midthoracic laminectomy a very vas-cular extradural mass was removed, confirmed to be a benign arteriovenous mal-formation.' The patient made a complete neurological recovery. Because of the extent ofthe AVM, definitive surgical excision ofthe chest wall and mediastinal components was not recommended. Embolisation will be reserved for recurrence of symptoms. Chest wall2 and extradural3 AVMs are uncommon. Extradural AVMs are usually located in the mid-thoracic region. They may extend into the mediastinum and paraspinal areas in a 'dumb bell' fashion but involve