Segmentectomy for bilateral pulmonary arteriovenous fistula with significant right to left shunt—a case report

Abstract

Pulmonary arteriovenous fistulas (PAVFs) are rare vascular malformations of the lung and bilateral lung involvement adds further to it. We are presenting a case report of 33-year-old male patient who presented with cyanosis (SpO2 76 %) and breathlessness. Investigations revealed bilateral pulmonary arteriovenous fistula involving both the lower lobes. PAVFs were large, isolated and had aneurismal changes (8 × 6 cm on the right side and 3 × 3 cm on the left side). Staged lung resection was planed and right anterior and medial basal segmentectomy was done. Patient got rid of cyanosis and saturation has improved to 96 %. He was advised second surgery on the left side after 1 month but patient turned up after 7 years with massive haemoptysis and pain chest. Investigation showed that there was fistula on the left side which has increased in size to 5 × 4 cm. Left lateral basal segmentectomy was done. Patient did well and became asymptomatic. This report highlights that large and localized pulmonary arteriovenous fistula should be treated surgically sparing as much as lung tissue to preserve pulmonary function.