Successful embolization of a clinically significant pulmonary arteriovenous malformation

Abstract

The authors present the clinical case of a 59-year-old female patient with a history of peripheral desaturation, which was detected in the perioperative period 4 years earlier. She reported exertional dyspnea, quantified as grade 2 on the Modified Medical Research Council (mMRC) Dyspnea Scale (walks slower than people of the same age because of dyspnea or has to stop for breath when walking at her own pace), and morning cough with mucoid sputum and denied platypnea, epistaxis, telangiectasias and hemoptysis. A computed chest tomography scan revealed a contrast-enhanced lesion on the right upper lobe with an afferent and two efferent vessels compatible with pulmonary arteriovenous malformation. The transesophageal echocardiogram revealed an important right-left shunt compatible with arteriovenous fistula in the pulmonary circulation. An angiography confirmed the diagnosis and a selective embolization of the afferent artery was performed with resolution of symptoms.

Keywords: desaturation; dyspnea; pulmonary arteriovenous malformation; right–left shunt.

FIGURE 1

Computed chest tomography with a 3 × 4cm contrast‐enhanced lesion on the right upper lobe (A), apparently with an afferent with 8 mm diameter and an efferent vessel (B), compatible with pulmonary arteriovenous malformation. (C) Transesophageal echocardiography with contrast showing bubbles in the left ventricle. Aortography with pulmonary arteriovenous malformation with reflux of contrast to the heart (D) followed by selective embolization of the afferent artery with two AVPlugs (E).