Pulmonary arteriovenous malformation

诊断

You may need several tests so that your healthcare team can diagnose and evaluate a pulmonary arteriovenous malformation (PAVM).

Tests may include:

• Chest CT scan. This test uses X-ray techniques to create images of the lungs. It is an important test for finding and evaluating a PAVM. It can show the PAVM along with its feeding artery and draining vein. This helps your healthcare team tell a PAVM from a lung nodule or another structure that may look similar.
• Bubble study. This test also is called transthoracic contrast echocardiography. Tiny bubbles in a saline solution are injected into a vein while ultrasound pictures of the heart are taken. If the bubbles appear in the left side of the heart after a short delay, this can suggest that a shunt is present through the lungs. A bubble study can show that blood is bypassing the usual blood flow through the lungs.
• Chest X-ray. A chest X-ray is an imaging test that may show some PAVMs, but it can miss smaller ones.
• Pulmonary angiography. This test may be done when your healthcare team plans to perform a procedure called embolization to treat the PAVM. Pulmonary angiography uses a long, thin tube called a catheter and a substance called contrast that helps to show the PAVM's blood vessels. This test helps your healthcare team identify the feeding artery or arteries that need treatment.

On an imaging test, a PAVM can look like a small, rounded spot in the lung called a lung nodule. But a PAVM is not a lung nodule. A PAVM is an unusual connection between blood vessels.

治疗

Treatment for pulmonary arteriovenous malformation (PAVM) aims to block the unusual blood flow through a PAVM. It also aims to prevent serious complications such as stroke, brain abscess and coughing up blood. Embolization is the main treatment for PAVMs that need treatment.

In the past, a feeding artery measuring 3 millimeters (mm) wide was commonly used as a cutoff for deciding whether to treat a PAVM. The 3-mm cutoff is no longer considered an absolute rule. With advances in embolization techniques, some PAVMs with smaller feeding arteries can be treated.

Embolization

Embolization is a procedure that blocks blood flow through the PAVM.

During embolization, a healthcare professional places a thin tube called a catheter into a vein and guides it through the blood vessel to the PAVM.

An imaging test called pulmonary angiography helps show the feeding artery and draining vein so your care team can plan where to block the blood flow.

Your care team places small devices such as coils or plugs through the catheter to block blood from flowing through the PAVM. Blocking the feeding artery lessens or stops the right-to-left shunt.

After embolization, you may need to rest in bed for a few hours. PAVM embolization often can be done in a procedure room in an outpatient setting. Many people can go home the same day. Some people have chest pain after the procedure.

Serious complications from embolization are not common, but they can occur. A treated PAVM also can stay partly open or regain blood flow later. This is one reason that follow-up is important.

Surgery

Surgery is a procedure that involves removing the PAVM or the part of your lung that contains it. Your healthcare team may consider surgery depending on your condition and which treatment benefits you. Care teams use surgery much less often than embolization to treat PAVMs.

Follow-up after treatment

Follow-up imaging helps your healthcare team check whether a treated PAVM stays closed. It also can help your care team identify a PAVM that still has blood flowing through it or that has regained blood flow. You may need long-term follow-up if some treated PAVMs stay open or regain blood flow.

Prognosis

Pulmonary arteriovenous malformations (PAVMs) are often effectively treated with embolization. Serious complications from the procedure are not common.

However, some treated PAVMs can stay open or regain blood flow over time. You may need long-term follow-up for your care team to check treated PAVMs and look for PAVMs that need more treatment.

Untreated PAVMs can lead to serious complications such as stroke, brain abscess, low oxygen levels and bleeding.

准备您的预约

If a healthcare professional thinks you might have pulmonary arteriovenous malformations (PAVMs), you may be referred to a doctor trained in lung disease, also called a pulmonologist.

Here's some information to help you get ready for your appointment.

What you can do

• Ask if there is anything you need to do before your appointment. For example, your healthcare professional may tell you not to eat or drink for a short time before certain tests.
• Write down your symptoms, including any that may not seem related to PAVMs.
• Write down important personal information. This includes any major stresses or recent life changes.
• Make a list of all the medicines, vitamins and supplements you take. Include those you buy without a prescription. Also include the doses.
• Consider inviting someone you trust to go with you. Someone who goes with you can help you remember information you are given and what you discuss.
• Write down questions to ask the healthcare team.

Writing down questions can help you make the most of your visit. For a PAVM, some basic questions to ask your care team include:

• What's the most likely cause of my symptoms?
• What tests do I need? How do I get ready for them?
• I feel OK. Do I still need treatment?
• Which treatments may help me?
• Are there other treatment options?
• I have other health conditions. How can I best manage them together?
• Do I need to change my activities, exercise or diet?
• Should I see a specialist?
• Is there any information that I can take home with me?
• What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team is likely to ask you many questions. Being ready to answer them may save time to go over any questions or concerns you want to spend more time on. Your care team may ask:

• When did you first have symptoms?
• Do you always have symptoms, or do they come and go?
• How much do your symptoms affect your daily activities?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?