Multiple Small Pulmonary Arteriovenous Fistulas

Abstract

The condition of multiple small pulmonary arteriovenous fistulas is discussed with regard to diagnosis, complications, and possible etiology. The lesions are believed to be either congenital in origin or secondary to cirrhosis of the liver with portal hypertension. Surgical therapy has not been attempted in this condition because of the diffuse nature of the lesions. A case is discussed wherein the diagnosis of diffuse small pulmonary arteriovenous fistulas was made by cardiac catheterization. The catheter was passed through an atrial septal defect into a pulmonary vein. Difference in oxygen saturation between the pulmonary vein and pulmonary capillaries (pulmonary vein wedge) revealed conclusive evidence of a right-to-left shunt in this area. Etiologic and therapeutic considerations are discussed in view of recent literature on this subject.