Pulmonary arteriovenous malformation: a case report

Abstract

Pulmonary arteriovenous malformation (PAVM) is an uncommon pulmonary condition characterized by communications between the arterial and the pulmonary venous system. This disease is often related to hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, and in some cases can be classified as idiopathic. It can be either congenital or acquired, some cases may be asymptomatic, while a less percentage may present symptoms like dyspnea, hemoptysis, hypoxemia, skin telangiectasias, epistaxis and may be associated with significant morbidity and mortality. PAVM should be suspected by clinical manifestations and chest X-ray altered imaging, and the diagnosis should be confirmed by a contrast-enchaced chest computed tomography (CT) scan and pulmonary angiography, being the gold standard test. The most effective therapy is embolization, but some patients may need alternative treatments, like surgical excision or lung transplantation, as an alternative reserved for severe cases where other interventions have been ineffective, or due to the lack of resources to perform the embolization procedure because of the socioeconomic reality of the country. We report the case of a patient with a 5-year history of hemoptysis, cough, dyspnea, and fatigue, with a possible apparent cause related to a surgical procedure performed in 2018. Initially, the differential diagnosis was aspergillosis, but after conducting laboratory tests and a contrast-enhanced CT scan, the diagnosis of arteriovenous malformation in the right lower lobe was made, which was successfully corrected surgically.