Pulmonary arteriovenous malformations.
A 34-year-old gentleman, presented with a recurrent headache, redness of the face, and shortness of breath for six months. He had congestive palpebral conjunctiva, reddish face and drumstick appearance of the fingers with loss of Lovibond angle. His SpO2 82 % at room air. Investigation showed hemoglobin 250 g/L, hematocrit 69%, and pO2 of 44.4 mm of Hg. Erythropoietin (EPO) level was normal. CT pulmonary angiography images showed multiple pulmonary arteriovenous malformations (PAVMs) in the bilateral lower lobe of the lung. The patient underwent phlebotomy to relief the symptoms of hyperviscosity. PAVMs is abnormal communication between the pulmonary artery and pulmonary vein without capillary bed leading to right to left shunt physiology. It can be congenital (80% cases) and acquired (20%). Clinically PAVMs presents as a classical triad of dyspnea, cyanosis, and clubbing.