An unusual case of pulmonary arterio-venous fistula (PAVF)

Pulmonary Arteriovenous Fistula (PAVF) is an abnormal communication between the pulmonary veins and pulmonary arteries. Most individuals may have the condition since birth (congenital occurrence), but it can also be an acquired condition. Most individuals with Pulmonary Arteriovenous Fistula also have a hereditary haemorrhagic telangiectasia. The common signs and symptoms of Pulmonary Arteriovenous Fistula are shortness of breath, haemoptysis, chest pain, dizziness, and syncope. Pulmonary Arteriovenous Fistula is treated with embolization and surgery. PAVF are more common in females than males. Complete evaluation of medical history along with a thorough physical examination required to diagnose PAVF. The CT scan is more sensitive than a chest x-ray in establishing a diagnosis. However pulmonary angiography is the gold standard. Many clinical conditions may have similar signs and symptoms. PAVF is associated with variety of complications, some of which may be life-threatening. These may include: Stroke, bleeding in the lung and brain abscess. Typically, individuals with mild conditions presenting no symptoms may not require any treatment. The treatment of Pulmonary Arteriovenous Fistula may include: Embolization and surgery (the later may be required in a cases not responding to embolization). During surgery, the abnormal vessels are removed along with surrounding lung tissue. We report a rare case of large right pulmonary arterio-venous fistula (PAVF) which was misdiagnosed as mass lung in a 30-year-old lady who presented with generalized seizures due to secondary polycythemia, right sided hemiparesis, central cyanosis and clubbing. She had hypoxemia while breathing ambient air and little improvement with 100% oxygen. Diagnosis was clinched by pulmonary CT angiography which revealed a large PAVF.