Transcatheter treatment of large complex pulmonary arteriovenous malformation

Pulmonary arteriovenous malformation (PAVM) is a rare clinical condition with abnormal direct communication between pulmonary arteries and pulmonary veins causing intrapulmonary right to left shunt. The incidence of PAVM is 2.5/100000 population. Female to male ratio is 2:1. Clinical manifestations may range from asymptomatic to exertional dyspnoea, cyanosis, clubbing, hemoptysis or cerebral abscess. CT pulmonary angiography is the gold standard for diagnosis of PAVMs. Treatment of choice in majority of cases of PAVMs is transcatheter embolotherapy with balloons, stainless steel coils or vascular plugs.
We present a 26-year old male who developed exertional dyspnea during an acute febrile illness in COVID-19 pandemic. During investigation for COVID-19, PAVM was diagnosed. Infection was not considered as the cause of PAVMs as the fever was of very short duration and PAVMs were of large size with large feeder arteries. We speculated that PAVMs were already present and were asymptomatic until the acute febrile episode precipitated the exertional dyspnea. We, therefore, considered the PAVMs as the cause of exertional dyspnea in the absence of lung parenchymal disease and treated the PAVMs percutaneously with vascular plugs.
Our case is a good example where even large PAVMs may be asymptomatic until some acute illness precipitates symptoms, and also where large PAVMs can be successfully treated percutaneously.