Presentation
Check up. Incidental finding.
Patient Data
CT non-contrast shows a homogeneous lesion, well-circumscribed located at the anterior segment of the right lower lobe and connected with the blood vessels.
CTPA reveals enhancement of the feeding artery from the right pulmonary artery, aneurysm part, and a draining vein to right inferior pulmonary vein.
Case Discussion
Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between the pulmonary artery and the pulmonary vein. Pulmonary arteriovenous fistula is another term used to describe PAVM.
PAVMs usually are hereditary with most associated with HHT (Hereditary Hemorrhagic Telangiectasia).
PAVM may be:
- single or multiple
- unilateral or bilateral
- simple (blood through a single artery) or complex (blood through 2 or more arteries)
Physiologic consequences depend on the degree of the right-left shunt and include hypoxemia, dyspnea and cyanosis.
Modalities for diagnostic are:
- echocardiography
- radionuclide perfusion lung scanning
- computed tomography (CT)
- magnetic resonance imaging (MRI)
- pulmonary angiography (gold standard modality) - nowadays largely replaced by CT angiograms as in this case
Treatment and management:
- TCE (Percutaneous Transcatheter Embolization) is the gold standard for treatment PAVM that can use coils, Amplatzer vascular plugs (AVPs) or balloon devices
- surgery is rarely necessary and used as an emergency procedure to control bleeding and when loss of lung is justified
- follow-up
Special thanks to professor Anuchit Ruamthanthong.