High-output congestive failure in a patient with pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations are rare vascular malformations that usually present with dyspnea and cyanosis in young adults. With the exception of infants and newborns, pulmonary arteriovenous malformations rarely cause congestive heart failure. The authors describe an unusual case in which an elderly female presented with severe dyspnea, hypoxemia, and high-output heart failure. Spiral CT of the chest and pulmonary angiography revealed three large, lower-lobe arteriovenous malformations that were successfully embolized, leading to resolution of her hypoxemia and symptoms.