Author + information
- Received November 10, 2012
- Revision received February 4, 2013
- Accepted February 6, 2013
- Published online August 27, 2013.
- Achyut Sarkar, MBBS, MD, DM,
- Naveen Chandra G S, MBBS, MD,
- Bhuban Majhi, MBBS, MD, DM,
- Saroj Mandal, MBBS, MD, DM,
- Arindam Pande, MBBS, MD and
- Imran Ahmed, MBBS, MD
A 24-year-old man presented for the evaluation of progressive bluish discoloration of the lips and hands that he had noticed since childhood and recurrent bouts of hemoptysis. Systemic examination was unremarkable except for central cyanosis and clubbing. Resting oxygen saturation was 60% in room air. Electrocardiogram and echocardiogram were essentially normal. Contrast echocardiogram was performed and showed bubble contrast in the left chambers, raising suspicion of pulmonary arteriovenous fistula (Online Video 1). Diagnostic pulmonary angiography was done (Online Videos 2 and 3) and revealed a large communication between the right pulmonary artery to the left atrium. A computed tomography pulmonary angiogram with 3-dimensional reconstruction was obtained and showed a large pulmonary arteriovenous fistula, directly communicating the right pulmonary artery to the left atrium (A, B, C), along with aortopulmonary collaterals in the form of a large tortuous and dilated bronchial artery supplying the right pulmonary artery (D, E, arrows). This is a rare variant of pulmonary arteriovenous fistula, and association with aortopulmonary collaterals is extremely rare. ART = artery; DSC = descending; RT = right.
- Received November 10, 2012.
- Revision received February 4, 2013.
- Accepted February 6, 2013.
- American College of Cardiology Foundation