Pulmonary arteriovenous fistula secondary to historic thoracic shrapnel injury: presenting features and interventional approach.

Abstract

Background: A chronic pulmonary arteriovenous fistula (PAVF) post penetrating thoracic injury is rare; this case demonstrates the presentation, diagnostic implications and a successful endovascular approach to close it.

Case presentation: We report the case of a rare pulmonary arteriovenous fistula in a 50-year-old man secondary to historic thoracic shrapnel injury. He had a positive bubble study on echocardiography; CT pulmonary angiogram identified a pulmonary arteriovenous fistula. He underwent successful repair with an endovascular approach.

Conclusion: PAVF can result from penetrating chest trauma. An intra-pulmonary shunt should be suspected in the setting of hypoxaemia refractory to oxygen therapy and when there is no evidence of an intra-cardiac shunt. Endovascular intervention can facilitate definitive treatment by employing a plug-in-stent technique.