Surgical review
Pulmonary arteriovenous fistula

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Abstract

From the world literature as well as from personal correspondence we have collected 147 cases of pulmonary arteriovenous fistula and have added one case of our own, making 148 known cases. Pulmonary arteriovenous fistula is a variant of hereditary hemorrhagic telangiectasis. The lesions in the lung tend to be multiple. The pathologic physiology of pulmonary arteriovenous fistula is due to the shunt between the pulmonary artery and vein. Unoxygenated blood is thereby shunted back to the heart and to the systemic circulation. The degree of symptoms depends upon the amount of unoxygenated blood shunted from the pulmonary artery into the pulmonary vein. When the shunt is small, no symptoms result. In a typical case of pulmonary arteriovenous fistula the characteristic findings are telangiectasis, cyanosis, clubbing of the fingers and toes, exertional dyspnea, polycythemia (frequently alleviated by hemorrhage from the telangiectases), an opacity (or opacities) seen in the chest x-ray film and a murmur heard over the lesion in the lung. Central nervous system manifestations ranging from attacks of numbness, tingling, headaches, dizziness, transient weakness and paralysis to loss of consciousness, paralysis, convulsions and brain abscess are of frequent occurrence. Treatment is surgical excision of the fistula. Lung tissue should be conserved as pulmonary arteriovenous fistula tends to be multiple and may occur in both lungs necessitating bilateral thoracotomy.

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