title: A large pulmonary arteriovenous malformation causing cerebrovascular accidents.
abstract: The incidence of pulmonary arteriovenous malformations (PAVMs) is 2.5 in 100,000. 80% are associated with Osler-Weber-Rendu syndrome or hereditary haemorrhagic telangiectasia. We report the case of a 70-year-old man with a 6 cm spherical mass incidentally found on chest X-ray. There was a localised systolic bruit over the right lower zone posteriorly; however, he was asymptomatic. He had suffered a stroke, affecting his right hand and his speech, from which he recovered. He experienced regular transient ischaemic attacks, on an average of every 2 months. He underwent a right lower lobectomy and on ligating the right lower lobe pulmonary artery the saturations of oxygen rose from 92% to 97%, demonstrating a significant right to left extracardiac shunt. Postoperative recovery was excellent and 1 year later the patient reports no further neurological symptoms. 40% of such lesions exhibit symptoms, however, only one-third are neurological. Treatment should be by percutaneous embolisation.
authors.affiliation: Mater Dei Hospital, Msida, Malta.
authors.forename: David
authors.initials: D
authors.lastname: Sladden
authors.affiliation: Mater Dei Hospital, Msida, Malta.
authors.forename: Aaron
authors.initials: A
authors.lastname: Casha
authors.affiliation: Mater Dei Hospital, Msida, Malta.
authors.forename: Conrad
authors.initials: C
authors.lastname: Azzopardi
authors.affiliation: Department of Cardiac Services, Mater Dei Hospital, Msida, Malta.
authors.forename: Alexander
authors.initials: A
authors.lastname: Manche'
mesh_terms: D030301:Activin Receptors, Type II / Q000235:genetics / Q000378:metabolism; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis; D001165:Arteriovenous Malformations / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities; D011667:Pulmonary Veins / Q000002:abnormalities; D035583:Rare Diseases / Q000175:diagnosis / Q000209:etiology; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II