Arteriovenous Fistula of the Lung

Pulmonary arteriovenous fistulas are anomalous connections between the arteries and veins of a portion of the pulmonary vascular bed. Since the first clinical diagnosis of pulmonary arteriovenous fistula by Smith and Horton in 1939 (13), 200 cases have been reported. The detection by routine chest roentgenograms and photofluorograms of clinically silent spheroid pulmonary lesions has been largely responsible for an increasing frequency of diagnosis. It is now mandatory that a radiologist, confronted with a density in the lung parenchyma, include arteriovenous fistula in the differential diagnosis. This is of prime importance, since the surgical approach may differ from that for the usual “coin lesion.” Case Reports Case I: On Feb. 15, 1958, a 27-year-old Caucasian sailor was admitted to the St. Albans Naval Hospital. A routine chest roentgenogram for discharge from the service revealed a density in the right lower lobe. History and physical examination were unremarkable. A murmur within the right chest could not be detected and examination of the mucous membranes and skin failed to reveal telangiectasia. There was no history of familial disease. Oxygen saturation and pulmonary function studies were normal. The roentgenograms are shown in Figures 1–4. A segmental resection of the fistula in the right lower lobe was performed with an uneventful postoperative course. Case II: A 24-year-old Caucasian sailor was admitted to the U. S. Naval Hospital in December 1955 because of a mass in the left lung, detected on an annual chest roentgenogram. He was asymptomatic and had never had any operation or serious illnesses. System review and familial history were unremarkable. Physical examination failed to reveal telangiectasia or other abnormalities except for a soft, sharply localized systolic murmur in the left posterior axillary line over the eighth rib. This did not change with respiration. Results of laboratory studies were within normal limits. Oxygen saturation of the arterial blood was normal. Roentgen studies are shown in Figures 5–7. At surgery, a wedge resection removed the fistula intact and no murmurs or thrills were detectable in the remaining lung. The postoperative course was uneventful. Case III: A 33-year-old Caucasian female was admitted to the St. Albans Naval Hospital in September 1945. During a bout of acute tonsillitis a chest roentgenogram revealed a mass in the left lung, adjacent to the hilus. History and physical examination were otherwise unremarkable and there were no familial diseases. Angiocardiography confirmed the diagnosis of a pulmonary arteriovenous fistula but surgery was refused by the patient.