Pulmonary arteriovenous malformations (PAVM) are abnormal communications between pulmonary veins and arteries . Alternative names include pulmonary arteriovenous fistulae, pulmonary arteriovenous aneurysms, cavernous angiomas of the lung, and pulmonary telangiectases . PAVM are uncommon, but they are an important consideration in the differential diagnosis of common pulmonary problems, including hypoxemia, pulmonary nodules, and hemoptysis.
Indications for diagnostic testing, the available diagnostic tests, and an approach to the diagnostic evaluation of suspected PAVM are reviewed here. The epidemiology, etiology, pathology, clinical features, and treatment of PAVM are discussed separately. (See "Pulmonary arteriovenous malformations: Epidemiology, etiology, pathology, and clinical features".)
PAVM should be suspected and a diagnostic evaluation initiated in individuals with one or more of the following characteristics:
●One or more pulmonary nodules on a chest x-ray are suspicious for PAVM. The features of a pulmonary nodule that make it suspicious for a PAVM are described separately. (See "Pulmonary arteriovenous malformations: Epidemiology, etiology, pathology, and clinical features", section on 'Imaging findings'.)
●Stigmata of right-to-left shunting, such as dyspnea, hypoxemia, polycythemia, clubbing, cyanosis, cerebral embolism, or a brain abscess.