SELECTIVE EMBOLIZATION AND SURVEILLANCE OF MULTIPLE BILATERAL PULMONARY ARTERIOVENOUS MALFORMATIONS: A CASE REPORT

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between the pulmonary arterial and venous circulations that produce intrapulmonary right to left shunting and may predispose e patients to serious neurologic and hemorrhagic complications. Although some patients present with dyspnea, hypoxemia, or hemoptysis, PAVMs may be clinically silent and discovered incidentally. We report a 45-year-old woman with multiple bilateral PAVMs initially identified on abdominal computed tomography. Dedicated chest computed tomography angiography characterized the lesions, and agitated-saline transthoracic echocardiography confirmed an intrapulmonary right-to-left shunt. Three dominant left lower-lobe PAVMs were selectively embolized with detachable coils, with elimination of flow on completion angiography. Smaller right-sided PAVMs, whose feeding arteries were considered too small for intervention, remained stable on surveillance imaging. Recurrent epistaxis and multiple PAVMs raised suspicion for hereditary hemorrhagic telangiectasia, although available clinical criteria were insufficient for a definite diagnosis. This case demonstrates a lesion-specific, longitudinal approach to multifocal PAVMs in which embolization of technically amenable malformations is combined with surveillance of smaller residual lesions.