398 JAPI • VOL. 51 • APRIL 2003 Case Report Pulmonary Arteriovenous Malformation Treated with Embolotherapy S Saxena * , Dipti Gothi ** , JM Joshi *** Abstract Pulmonary arteriovenous malformations (PAVM) represent pulmonary vascular anomalies and in majority of cases are congenital in origin. We report a case that presented with predominant complaints of dyspnoea on exertion and cyanosis. Clinical examination revealed a bruit in the left lower interscapular and infrascapular areas which led us to suspect PAVM. The diagnosis was established on the basis of computed tomography (CT) thorax with three-dimensional virtual reconstruction technology (3D VRT) images and pulmonary angiography. Patient was successfully treated by embolotherapy using steel coils, which resulted in 90% exclusion of the aneurysm from the rest of the systemic circulation. normal limits. Arterial blood gas estimation showed pH- 7.348, PCO 2 -41.1, PO 2 - 47.6, and HCO 3 - 22.0 mmols/L. Chest radiograph (Fig. 1) showed a sharply defined rounded opaciety of uniform density in the left lower zone. The presence of bruit on clinical examination and evidence of a well-defined mass on chest radiography raised suspicion of pulmonary arteriovenous malformation and the patient was subjected to computed tomography (CT) thorax (plain and with contrast) with three dimensional virtual reconstruction (3-VRT) images and pulmonary angiography. The computed tomography image revealed presence of an *Resident; **Lecturer; ***Professor and Head, Department of Respiratory Diseases, BYL Nair Charitable Hospital and TN Medical College, Mumbai Central, Mumbai - 400 008. Received : 13.2.2003; Accepted : 4.3.2003 INTRODUCTION P ulmonary arteriovenous malformations (PVAM) are rare pulmonary vascular anomalies. They can be defined as direct communications between the branches of pulmonary artery and pulmonary veins, without intervening pulmonary bed. 1 These lesions usually represent congenital malformation, with the exception of very rare acquired cases. The fundamental defect in pulmonary arteriovenous malformation, is right to left shunt from the pulmonary artery to the pulmonary vein, the degree of shunt is what determines the clinical effects on the patient. 2,3 We report a case of pulmonary arteriovenous malformation treated successfully with pulmonary arterial embolisation using steel coils. CASE REPORT A 55 year old female, housewife, presented with symptoms of left sided, dull aching intermittent non-pleuritic chest pain and dyspnoea on exertion for the past 10 years. On examination she had a pulse rate of 85 per minute, blood pressure of 150/90 mm of Hg and oxygen saturation of 85% on pulse oximetry. There was grade - III clubbing with central cyanosis. Respiratory system examination revealed ‘bruit’ in the left lower interscapular and infrascapular areas. Cardiovascular, abdominal and neurological examinations were unremarkable. Investigations showed haemoglobin of 16.8 gm/dl, packed cell volume of 51%; white blood cell count of 13,600 per cu mm; polymorphs 86%, lymphocytes 13%, and eosinophils 1%. Other biochemical parameters were within Fig. 1 : Chest radiograph postero-anterior view showing sharply defined rounded opacity of uniform density in the left lower zone.