O3204: Mandibular arteriovenous malformation: a rare but serious diagnosis

Introduction: Mandibular arteriovenous malformations are a rare diagnosis in the pediatric population which can have deadly consequences. Children can either be born with these malformations or they can be acquired due to trauma and/or surgery.

Case Description: We are describing the case of a previously healthy seven-year-old patient who presented with the chief complaint of hematemesis. Endoscopy was done which ruled out any gastrointestinal pathology; post-procedure patient had another bleeding episode in which the possible source was identified in the oropharynx, thus the patient remained intubated and was transferred to our institution for otorhinolaryngologist (ENT) evaluation. Initial work up at admission included maxillofacial Computed Tomography (CT) angiography due to high suspicion of arteriovenous malformation. While in the intensive care unit, the patient went into cardiac arrest secondary to hemorrhagic shock with quick return of spontaneous circulation. Further evaluation revealed an active bleeding source in the left mandibular region. Images from maxillofacial CT angiography confirmed arteriovenous malformation in the left premandibular region. Neuroendovascular team successfully embolized the left facial and maxillary artery without any further bleeding episodes. Condition improved allowing discharge from the hospital a few days later.

Discussion: Mandibular arteriovenous malformations are sparse in the pediatric population, thus it is important to remain aware of the possible diagnosis in children presenting with acute hemorrhage from the oral cavity to prompt appropriate treatment. In our case, although the patient had an acute deterioration, the source of bleeding was identified promptly for which adequate management was able to be provided in a timely manner. Our goal is to create awareness about this diagnosis in order to prevent devastating consequences.

Conclusion: As previously mentioned, mandibular arteriovenous malformations are extremely rare in the pediatric population and have a high rate of mortality, thus it is imperative to have a high suspicion for it in patient’s presenting with massive bleeding from the oral region.