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Pulmonary arteriovenous fistula

Arteriovenous malformation - pulmonary

Pulmonary arteriovenous fistula is an abnormal connection between an artery and vein in the lungs. As a result, blood passes through the lungs without receiving enough oxygen.

Causes

Pulmonary arteriovenous fistulas are usually the result of abnormal development of the blood vessels of the lung. Most occur in people with hereditary hemorrhagic telangiectasia (HHT). These people often have abnormal blood vessels in many other parts of the body.

Fistulas also can be a complication of liver disease or lung injury, although these causes are much less common.

Symptoms

Many people have no symptoms. When symptoms occur, they can include:

Exams and Tests

The health care provider will examine you. The exam may show:

  • Abnormal blood vessels (telangiectasias) on the skin or mucous membranes
  • Abnormal sound, called a murmur when a stethoscope is placed over the abnormal blood vessel
  • Low oxygen when measured with a pulse oximeter

Tests that may be done include:

Treatment

A small number of people who have no symptoms may not need treatment. For most people with fistulas, the treatment of choice is to block the fistula during an arteriogram (embolization).

Some people may need surgery to remove the abnormal vessels and nearby lung tissue.

When arteriovenous fistulas are caused by liver disease, the treatment is a liver transplant.

Outlook (Prognosis)

The outlook for people with HHT is not as good as for those without HHT. For people without HHT, surgery to remove the abnormal vessels usually has a good outcome, and the condition is not likely to return.

For people with liver disease as a cause, prognosis depends on liver disease.

Possible Complications

Complications may include:

  • Bleeding in the lung
  • Stroke due to blood clot that travels from the lungs to the arms, legs, or brain (paradoxical venous embolism)
  • Infection in the brain or heart valve, especially in patients with HHT

When to Contact a Medical Professional

Contact your provider if you often have nosebleeds or difficulty breathing, especially if you also have a personal or family history of HHT.

Prevention

Because HHT is often genetic, prevention is not usually possible. Genetic counseling may help in some cases.

Open References

References

Prabhudesai V, Faughnan ME. Pulmonary vascular anomalies. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 88.

Stowell J, Gilman MD, Walker CM. Congenital thoracic malformations. In: Shepard JO, ed. Thoracic Imaging: The Requisites. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 8.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

 

Review Date: 7/31/2022

Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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