Case

A 45-year-old man with no known chronic medical illness presented with insidious onset of exertional dyspnoea and left pleuritic chest pain. He was pale on physical examination and left chest percussion note was dull. Otherwise, he had no telangiectasia, cyanosis or finger clubbing. No family history of telangiectasia or bleeding episodes were reported, he also denied any history of epistaxis or haemoptysis. Chest roentograph on admission demonstrated left pleural effusion. Transthoracic ultrasound showed a large thin-walled elongated hypoechoic nodule surrounded by collapsed lung and loculated hyperechoic pleural fluid (figure 1A, arrow). Colour Doppler ultrasound established turbulent flow within the nodule (figure 1B, arrow) which raised the suspicion of pulmonary arteriovenous malformation (PAVM). His haemoglobin level was 5.5 g/dL. Urgent CT thorax revealed multiple PAVMs with the largest at the left lower lobe, arising …