Gastric Fundal Arteriovenous Malformation Presenting as Isolated Anemia and Dyspnea

Arteriovenous malformations (AVMs) are rare, abnormal connections between arteries and veins. This aberrant circulation leads to rapid arterial blood flow into the venous system, resulting in inadequate tissue oxygenation and increased intravascular pressure, which can predispose to rupture. AVMs are typically located in the brain or spinal cord; however, this case highlights an atypical location in the gastric fundus. Known as a Dieulafoy's lesion, this gastrointestinal (GI) AVM represents a rare, clinically elusive diagnosis in the setting of an unclear or unexplained GI bleed. A 62-year-old male patient with a history of five coronary artery bypass grafts (CABG), paroxysmal atrial fibrillation (PAF), heart failure with preserved ejection fraction (HFpEF), hypertriglyceridemia, and prior GI bleed presented to the emergency room with complaints of shortness of breath, worse with exertion, over the last three weeks, with associated pre-syncopal episodes and palpitations. Laboratory work and esophagogastroduodenoscopy (EGD) confirmed a 2 mm bleeding gastric fundal AVM. Similar cases of this lesion have been reported in the literature, though variations exist, as will be described later in the discussion. This case underscores the importance of considering uncommon GI sources of bleeding, such as Dieulafoy's lesion, in patients with unexplained anemia and cardiopulmonary symptoms.