Pulmonary arteriovenous fistulas: increase in shunt at high lung volume

Intrapulmonary shunt measured in the sitting position by the oxygen breathing method increased at total lung capacity in 7 of 8 patients with pulmonary arteriovenous fistulas. This may explain the clinically noted increased murmur over a fistula on inspiration. The finding of an increased intrapulmonary shunt at total lung capacity might suggest the diagnosis in equivocal cases and provide a convenient test for follow-up after surgery.