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When is an AVM not an AVM?
  1. Alice Parry1,
  2. Amir Awwad2,3,
  3. Geoffrey Lie4,
  4. Matt Matson2,
  5. William Martin Ricketts1
  1. 1Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
  2. 2Department of Radiology, St Bartholomew's Hospital, London, UK
  3. 3UCL Institute of Cardiovascular Science, London, UK
  4. 4Department of Radiology, The Royal London Hospital, London, UK
  1. Correspondence to Dr Alice Parry, Department of Respiratory Medicine, Barts Health NHS Trust, London, London, UK; alice.parry{at}

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Pulmonary arteriovenous malformations (pAVMs) are abnormal connections between branches of the pulmonary artery and vein resulting in right-to-left shunting of blood. They are the most common pulmonary vascular malformations, with an estimated incidence of 1 in 2600, and typically congenital.1 There is a 30% lifetime risk of shunt related complications, such as stroke or cerebral abscess, secondary to paradoxical emboli.1 Rarer vascular malformations include pulmonary varix (PV), a congenital or acquired dilatation of a pulmonary vein and meandering pulmonary vein (MPV). In MPV, a single pulmonary vein, usually in the right hemithorax, takes an unusual tortuous route (often crossing fissures) before draining into the left atrium (LA).2 There are no known reports of these pathologies co-existing. Correct diagnosis is key as pAVMs require embolisation to reduce the risk of complications, while other vascular abnormalities may not need intervention.

A woman in her 30s presented at 8 weeks pregnant reporting worsening breathlessness on exertion. Saturations on air were 97%–100%. She had a pre-existing diagnosis of asthma (on inhaled therapy), allergic rhinitis and probable breathing pattern disorder. A CT pulmonary angiogram …

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  • Contributors AA, GL, MM and WMR were involved in review of the imaging. AP drafted and revised the manuscript with input from AA, GL, MM and WMR. The images were reconstructed and captions written by AA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.