Stroke resulting from an isolated pulmonary arteriovenous malformation

Isolated pulmonary arteriovenous malformations (PAVM) are rare, but can be responsible for paradoxical embolic events. It is important to recognise these situations early and intervene quickly to attain the best outcome. We describe the case of a 45-year-old woman with a long-standing history of migraines with aura who presented to the emergency department with left-sided weakness and slurred speech. Work-up was unclear and she was diagnosed with cryptogenic stroke. Follow-up transoesophageal echocardiogram was suggestive of an atrial septal defect, though no clear defect was evident. Pulmonary angiography revealed an isolated PAVM arising from the right lower lung segmental artery with a 2 mm feeding artery leading into 3-4 mm of dysplastic vessel that connects to the vein. The vessel was embolised successfully using a combination of a 4 mm Amplatzer Vascular Plug in the distal feeding artery and a 4 mm Nester coil proximally.