[A case of successful surgical treatment for bilateral pulmonary arteriovenous fistulas]

A 55-year-old man was admitted to our hospital with chief complaints of exertional dyspnea and chest x-ray abnormalities. On physical examinations, clubbing and systolic murmur were detected. The patient's hemoglobin rose to a level of 19.0 g/dl, with a rise in hematocrit to 58.8%. While the patient was breathing room air, the PaO2 was 52.8 mmHg, the PaCO2 33.3 mmHg and the pH 7.43. In chest x-ray film, oval well-margined 38 x 30 mm density with enlarged afferent and efferent vessels in the left upper lobe (lts4) and 15 x 13 mm "coin lesion" in the right lower lobe (rts7) were observed. Pulmonary angiography demonstrated that these lesions were arteriovenous fistulas. In cardiac catheterization, an estimated right to left shunt of 31.1% was calculated. Because of the exertional dyspnea and the large shunt, a segmentectomy of the lingula and a wedge resection of the rts7 were simultaneously performed. After the treatment, exertional dyspnea, hypoxia and polycythemia disappeared. As far as we know, this patient is one of the most elderly patients in Japan to be successfully treated surgically for bilateral pulmonary arteriovenous fistulas.