Differentials
Arteriovenous malformation (AVM) in the lung
SIGNS / SYMPTOMS
Patients often have advanced liver disease (e.g., cirrhosis) and may have clubbing, cyanosis or hypoxemia and/or portal hypertension, with splenomegaly, ascites and telangiectasia on the skin of the upper torso.
INVESTIGATIONS
Doppler imaging shows no color flow in the interatrial septum.
On injection of agitated saline, microbubbles are seen in the left atrium after several cardiac cycles (typically 4 to 8) and not immediately as seen in PFO.
A transesophageal echo may further delineate the exact crossover site.
If the microbubbles appear in the left atrium without crossing at the fossa ovalis, then AVM is possible.
Laboratory findings may show abnormal liver function tests, coagulopathy and low serum albumin.
Contrast-enhanced CT scanning may illustrate the AVMs.
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