A CASE OF PULMONARY ARTERIOVENOUS MALFORMATION PRESENTING AS HAEMOPTYSIS ABSTRACT NO:IRIA 1084

67 year old lady with complaints of haemoptysis

She is a known case of systemic hypertension with severe tricuspid regurgitation and PAH.

ECHO revealed severe tricuspid regurgitation with dilated right atrium and ventricle, suggestive of severe PAH

CT Scanogram

CT scanogram showing well defined radio dense nodule in right lower zone behind the cardiac shadow with pruning of pulmonary vessels ,enlarged pulmonary trunk and cardiomegaly

Plain CT showing well defined radio dense lobulated nodule in the posterior segment of right lower lobe.

Nodule is enhancing equal to the main pulmonary artery with appearance of early draining vein

Arterial supply from right lower

lobe pulmonary artery and

draining into right inferior pulmonary

vein

CT thorax features are consistent with pulmonary AV fistula supplied by right lower lobe pulmonary artery and venous drainage into inferior pulmonary vein

Diagnosis was confirmed with catheter angiography

Enlarged lower lobe pulmonary artery with sac filling with contrast draining into the inferior pulmonary vein

Endovascular embolisation device

Post embolisation

Post embolisation angiogram shows complete obliteration of the AV fistula

DiscussionPulmonary arterio venous malformations are lesions of pulmonary vasculature that by pass the capillary system flowing from arteries directly into veins

Incidence 2-3 per 100 000 population

More common in females than in male 2:1

Types

Simple -Single feeding artery empties into bulbous, non

septated aneurysmal segment -Single draining vein Complex -More than one feeding artery empty

into septated, aneurysmal segment - More than one draining vein

1.Surgery 2.Endovascular embolisation a. Coil b. vascular plug

Treatment options

CONCLUSIONPulmonary AVM is a rare vascular

malformation of lung.Contrast CT/CT angio has high specificity

and sensitivity.Endovascular embolisation is the most

effective and least invasive choice of treatment.

REFERENCE Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD

Imaging in Arteriovenous Lung Malformation medscape Nov 7, 2013

I khurshid ,G H Downie Postgrad Med J  Pulmonary arteriovenous malformation 2002;78:191197 doi:10.1136/pmj.78.918.191

 Hodgson CH,Kaye RL. Pulmonary arteriovenous fistula and hereditary telangiectasia.Dis Chest1963;43:449–55

Packard GB, Waring JJ. Arterio-venous fistula of the lung treated by ligation of the pulmonary artery. Arch Surg1945;56:724–40.