Pulmonary arteriovenous malformation masquerading as massive pulmonary thromboembolus.
We present a case of a 78-year-old male with hereditary haemorrhagic telangiectasia and severe hypoxia incorrectly diagnosed as pulmonary embolism following a false positive ventilation/perfusion scan. Anti-coagulation and thrombolysis was complicated by an upper gastro-intestinal haemorrhage. Pulmonary arteriovenous malformations resulted in a clinically significant right-left shunt and created an apparent perfusion defect evident upon radionuclide imaging, leading to diagnostic uncertainty and a potentially dangerous treatment modality.
McGrath
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Department of Anaesthesia and Intensive Care, The Northern Hospital, Melbourne, Victoria.
D000368:Aged; D000792:Angiography / Q000379:methods; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000628:therapy; D001784:Blood Gas Analysis; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities*; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D011667:Pulmonary Veins / Q000002:abnormalities*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio