Embolization of bilateral pulmonary arteriovenous fistulas: A case report

Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies that create right-to-left shunts and may lead to hypoxemia, neurologic complications, and progressive cardiopulmonary decline. We report the case of a 56-year-old woman with chronic obstructive pulmonary disease (COPD) and a prior ischemic stroke who presented with worsening exertional dyspnea and functional decline disproportionate to spirometry findings. Contrast-enhanced chest CT revealed a rare bilateral presentation, with 2 distinct PAVMs located in the right middle lobe and the posterior basal segment of the left lung. Hemodynamic assessment showed preserved pulmonary pressures without intracardiac shunting. Selective pulmonary angiography confirmed bilateral PAVMs with significant right-to-left shunting, and both lesions were treated successfully during a single endovascular session using detachable Interlock coils. Complete angiographic occlusion was achieved without procedural complications, resulting in immediate improvement in oxygenation and clinical status. This case highlights the importance of considering PAVMs in patients with unexplained or disproportionate respiratory symptoms and underscores the effectiveness and safety of contemporary coil embolization techniques for the management of bilateral lesions in a single session.