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IR Playbook pp 247-257 | Cite as

Pulmonary Angiography: Arteriovenous Malformation and Pseudoaneurysm

  • Jeffrey S. Pollak
Chapter

Abstract

Pulmonary arteriovenous malformations (PAVMs) are abnormal vessels in which pulmonary arteries directly connect to pulmonary veins without an intervening capillary bed. Most are congenital, generally in patients with autosomal dominant hereditary hemorrhagic telangiectasia (HHT), a disorder resulting in variable-sized arteriovenous malformations from telangiectases to larger connections that can occur on mucocutaneous surfaces and in the lungs, central nervous system, liver, and gastrointestinal tract. The most common presenting symptom is epistaxis. Patients with HHT should be screened for PAVM. Potential consequences of PAVM are hypoxemia with dyspnea, hemorrhage, and paradoxical embolization resulting in infarction within an organ (most frequently ischemic stroke) or abscess formation (especially brain abscess). Treatment consists of embolization of larger PAVMs, antibiotics before procedures most likely to create bacteremia (most clearly dental procedures), and avoidance of intravenously introduced air or clots. Patients are followed for life to assess for reperfusion of embolized lesions and enlargement of untreated PAVM.

Pulmonary artery pseudoaneurysms are another rare manifestation and most commonly due to local infections or septic emboli from endocarditis, vasculitides, neoplasia, and trauma, with pulmonary hypertension likely playing an exacerbating role. Hemorrhage is the most common complication and can be life-threatening. Treatment options include embolization of the arterial supply of the aneurysm and embolization of the aneurysm itself, less commonly a stent graft and rarely surgery.

Keywords

Pulmonary arteriovenous malformation Hereditary hemorrhagic telangiectasia Right-to-left shunt Paradoxical embolism Brain abscess Pulmonary hemorrhage Hemoptysis Embolization Pulmonary artery pseudoaneurysm 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Biomedical Imaging, Section of Vascular and Interventional RadiologyYale University School of Medicine and Yale-New Haven HospitalNew HavenUSA

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