ROENTGEN ASPECTS OF PULMONARY ARTERIOVENOUS FISTULA

Abstract

ALTHOUGH it is only thirteen years since the first clinical diagnosis of a pulmonary arteriovenous fistula was made by Smith and Horton,¹ there are now more than 65 proved cases in the medical literature.² The clinical features of cyanosis and clubbed fingers, associated with polycythemia and a pulmonary murmur, enable the full-blown clinical syndrome to be easily recognized once the physician is aware of the entity. As emphasized by Goldman,³ a large proportion of the cases are associated with cutaneous and mucosal hemangiomata and telangiectases of a hereditary nature which probably represent a variant of Rendu-Weber-Osler disease (hereditary capillary telangiectasia). With the study of more cases it has become apparent that the classical clinical picture associated with a large pulmonary arteriovenous shunt and corresponding changes in the peripheral blood does not always occur. One or all of the prominent clinical manifestations may be absent, and the roentgen