CTICasesPulmonary Arteriovenous Malformation with Brain Abscess
Imaging findings
Chest CT shows a large, simple pulmonary arteriovenous malformation (AVM) in the right middle lobe with a dilated feeding artery and draining vein connecting to the right middle lobe pulmonary vein. A second, smaller AVM is present in the left upper lobe. Brain CT and MRI show a left-sided cerebral abscess with surrounding vasogenic edema and a right-sided subdural empyema.
Key takeaways
Pulmonary arteriovenous malformations (AVMs) are congenital vascular structures that lack a capillary bed, creating a right-to-left shunt. A critical complication of this shunt is the bypass of the pulmonary capillary filter, allowing septic emboli or bacteria from the systemic venous system to enter the systemic arterial circulation directly. This predisposes patients to brain abscesses and stroke. Multiple pulmonary AVMs are highly associated with hereditary hemorrhagic telangiectasia (HHT).
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