Pulmonary Arteriovenous Malformation Misdiagnosed As Chronic Obstructive Pulmonary Disease: A Case Report

Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies characterized by direct communication between the pulmonary arteries and veins, resulting in a right-to-left shunt and impaired gas exchange. Most cases are associated with hereditary hemorrhagic telangiectasia (HHT), while sporadic, complex lesions are uncommon and can be diagnostically challenging when clinical features overlap with more prevalent pulmonary disease. This is the case of a chronic smoker who was referred for pulmonary evaluation for suspected chronic obstructive pulmonary disease (COPD). She was found to have hypoxemia with cyanosis and digital clubbing. CT angiography (CTA) of the chest demonstrated right middle and right lower lobe PAVMs. Two consecutive interventions were performed to treat the malformations. She had persistent post-procedure hypoxemia, and a third intervention identified an additional large inferolateral right middle lobe PAVM with a smaller contributing branch, making this a case of a complex PAVM, which is an uncommon occurrence in patients without HHT.