Innumerable bilateral pulmonary arteriovenous malformations: percutaneous transcatheter embolization using Amplatzer vascular plug

We report an unusual and distinct case of innumerable bilateral pulmonary arteriovenous malformation (PAVM) in a 42-year-old patient presenting with significant right-to-left shunt resulting in severe dyspnea and with a history of stroke due to paradoxical embolization related to his PAVM. Because it was impossible to treat all his PAVMs, our aim was to treat those with a feeding artery measuring 3 mm or more in diameter, aiming to improve the patient's dyspnea and decrease the risk of paradoxical embolization. We safely and successfully embolized 8 of the patient's PAVMs, using a single Amplatzer vascular plug for each PAVM. The procedure did not result in significant improvement of the patient's symptoms. In similar cases with innumerable PAVMs, the expectations of symptom relief should be lowered and the patient should be informed that treatment will only offer protection from paradoxical embolization. To our knowledge, there are no similar cases previously described in the literature.