Background Pulmonary arteriovenous fistula is a rare disease with a direct connection between the pulmonary artery and the vein, and in most cases is congenital. In a proportion of patients, it can cause hypoxemia, cyanosis and dyspnea. The golden standard for the diagnosis of PAVF is pulmonary angiography. We experienced two cases of a daughter and a mother with PAVF diagnosed by contrast echocardiography, which is simple and sensitive for the detection of pulmonary arteriovenous fistula.
Case presentation Case 1:A 22-year-old female was admitted to hospital because of "unconsciousness for 3 hours after sudden seizures".CT showed left frontal cerebral arteriovenous malformation with hemorrhage, a nodule of upper lobe of left lung, arteriovenous malformation possible.Intracranial hematoma removal, arteriovenous malformation resection were performed urgently. Postoperatively, the patient presented severe hypoxemia. Contrast echocardiography showed continuous dense bubbles were visualized in the left heart from the third heart cycle following imaging in the right heart, , suggesting pulmonary arteriovenous fistula. Case 2 : The mother of the first patient, 44-year-old female, with no history of dyspnea, cyanosis,and stroke, was medically screened for suspected pulmonary arteriovenous fistula due to her daughter’s disease. Contrast echocardiography also indicated pulmonary arteriovenous fistula.
Conclusions Contrast echocardiography is an excellent tool for the detection of pulmonary arteriovenous fistula. Patients with suspected pulmonary arteriovenous fistula should be examined by chest radiography combined with contrast echocardiography as first line screening tests, especially in patients with severe condition.