Pulmonary arteriovenous malformation managed by VATS lobectomy

Area of Science:

• Cardiology
• Pulmonology
• Vascular Surgery

Background:

• Pulmonary arteriovenous malformations (PAVMs) involve abnormal connections between pulmonary arteries and veins, bypassing capillaries and leading to deoxygenated blood in the left heart.
• This condition often remains asymptomatic for extended periods, with common symptoms including exertional dyspnea, epistaxis, fatigue, and cyanosis.
• A serious complication is paradoxical embolism to the brain, potentially causing stroke or brain abscess.

Observation:

• A case report details the diagnosis and treatment of a young patient with PAVM following a bicycle accident.
• Comprehensive assessments revealed arteriovenous malformations with a significant 40% shunt in pulmonary circulation.
• Angiographic procedures were deemed unsuitable due to the PAVM's type and extent, necessitating video-assisted thoracic resection.

Findings:

• PAVMs are rare and frequently associated with hereditary hemorrhagic telangiectasia (HHT).
• Contrast echocardiography and contrast-enhanced CT scans are the preferred diagnostic methods.
• Conservative or pharmacological treatments are generally ineffective for PAVMs.

Implications:

• Early diagnosis and management of PAVMs are crucial, particularly in individuals with HHT.
• Embolization is the usual treatment, but extensive or diffuse PAVMs may require surgical resection.
• PAVMs should be considered in patients presenting with HHT signs, especially oral manifestations.