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(Circulation. 1999;100:e29-e30.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Pulmonary Arteriovenous Malformation

C. Andrew Brian, MD; R. Mark Payne, MD; Kerry M. Link, MD; W. Gregory Hundley, MD; James G. Warner, Jr, MD, EdD

From the Section of Cardiology (C.A.B., K.M.L., W.G.H., J.G.W.), Department of Pediatrics (R.M.P.), and Division of Radiologic Sciences (K.M.L., W.G.H.), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to James G. Warner, Jr, MD, EdD, Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045. E-mail jwarner@wfubmc.edu

	Introduction

 
A35-year-old white woman with a history of migraine headaches and a grade 2 systolic murmur presented with symptoms of slurred speech, left-sided facial droop, and left hemiparesis after a hysterectomy. These symptoms resolved over several days, and in an effort to identify a potential cardiac source of embolism, a transesophageal echocardiogram was performed. Findings were consistent with a right-to-left shunt, with intravenous saline contrast entering the left upper pulmonary vein (Figure 1A). An MRI study of the chest demonstrated a pulmonary arteriovenous malformation (AVM) in the left upper lobe (Figure 1B). The patient underwent pulmonary angiography, which confirmed the pulmonary AVM (Figure 2A) and also identified an additional AVM in the left lower lung.^{1 2} Multiple coils were placed to obliterate both AVMs (Figure 2B). The patient had no physical examination evidence of Osler-Weber-Rendu syndrome, and her systolic murmur was absent after the coil embolization. She was asymptomatic at a 6-month follow-up visit.

View larger version (60K): [in this window] [in a new window]   Figure 1. A, Multiplane transesophageal echocardiogram demonstrating saline contrast entering left upper pulmonary vein (LPV). LAA indicates left atrial appendage. B, MRI demonstrating an AVM (arrow) in anterior region of left upper lung.

View larger version (82K): [in this window] [in a new window]   Figure 2. A, Pulmonary angiogram showing pulmonary AVM in left upper lung. B, Multiple coils in place to obliterate AVM in left upper lung.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor . . . [Full Text of this Article]