Arteriovenous Malformation: The Daily PANCE Blueprint
Which of the following is the most common symptom of people with an underlying pulmonary arteriovenous malformation?
A. Dyspnea
B. Hemoptysis
C. Chest pain
D. Clubbing
E. Peripheral cyanosis
Answer and topic summary
The answer is A. Dyspnea
Pulmonary arteriovenous malformations (PAVMs) are a rare cardiovascular anomaly; they are abnormal communications between the pulmonary arteries and veins. It is important to consider them in a patient who presents with refractory hypoxemia or unexplained dyspnea. Clinical features include dyspnea (MC), hemoptysis, cyanosis, clubbing, murmurs, and possibly chest pain. They may also have non-pulmonary/cardiac signs (migraines, strokes, anemia, etc). They often occur in patients with underlying hereditary hemorrhagic telangiectasia (HHT). The initial best test of choice is a transthoracic contrast echocardiology (aka “bubble study”) to evaluate for the presence of an R to L shunt. Subsequent diagnostic tests include CTA chest. Preferred management is transcatheter embolization by IR.
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