Pulmonary arteriovenous malformation
Check up. Incidental finding.
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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.
1 case question available
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:
- 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
Special thanks to professor Anuchit Ruamthanthong.
- Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. (2013) Chest. 144 (3): 1033-1044. doi:10.1378/chest.12-0924 - Pubmed
- Duran C, Wake N, Rybicki FJ, Steigner M. Pulmonary Arteriovenous Malformation (PAVM): Multidetector Computed Tomography Findings. (2011) The Eurasian journal of medicine. 43 (3): 203-4. doi:10.5152/eajm.2011.45 - Pubmed