They enrolled 53 patients who had a TTCE grade 2 or 3 who underwent chest CT and were found to have the PAVM with a feeding artery >2 cm to receive a contrast-enhanced MRA. The sensitivity of contrast-enhanced MRA to detect PAVMs with a feeding artery size of >2cm was 92%, and the specificity ranged from 67% to 96%. MRA Pulmonary Arteries Without IV Contrast There is no role for the routine use of MRA pulmonary angiography without IV contrast in the workup of a patient suspected of a PAVM. Pertechnetate Albumin Pulmonary Scan There is no role for pertechnetate albumin pulmonary scan in a modern day practice. Historically, this technique was used to detect and quantify right to left shunting before and after treatment of a PAVM [34,35]. Radiography Chest The radiographic appearance of a lower lobe pulmonary nodule with a branching afferent artery and dilated efferent vein defines the classical appearance of PAVM on chest radiography. The sensitivity of chest radiography is 60% to 70% with a 98% specificity when the classical findings are present [36]. The afferent and efferent vasculature and smaller PAVMs may be difficult to see on a single-view chest radiograph. Best diagnostic results are obtained when a 2-view chest radiograph, posteroanterior view, and lateral view is performed [37]. US Echocardiography Transesophageal There is no role for TEE as a standalone diagnostic tool in the evaluation of PAVMs. The usefulness of TEE in the context of PAVM is to rule out intracardiac shunts [38]. Its ability to demonstrate the interatrial septum and the insertion of the pulmonary veins into the left atrium is useful to evaluate the anatomical variations [39]. US Echocardiography Transesophageal With IV Contrast TEE with IV agitated saline contrast material is not routinely used to diagnose PAVM. Contrast-enhanced TEE may be helpful to locate a PAVM based on the excellent visualization of the 4 pulmonary venous ostia as veins drain into the left atrium.
Pulmonary Arteriovenous Malformation PAVM . They enrolled 53 patients who had a TTCE grade 2 or 3 who underwent chest CT and were found to have the PAVM with a feeding artery >2 cm to receive a contrast-enhanced MRA. The sensitivity of contrast-enhanced MRA to detect PAVMs with a feeding artery size of >2cm was 92%, and the specificity ranged from 67% to 96%. MRA Pulmonary Arteries Without IV Contrast There is no role for the routine use of MRA pulmonary angiography without IV contrast in the workup of a patient suspected of a PAVM. Pertechnetate Albumin Pulmonary Scan There is no role for pertechnetate albumin pulmonary scan in a modern day practice. Historically, this technique was used to detect and quantify right to left shunting before and after treatment of a PAVM [34,35]. Radiography Chest The radiographic appearance of a lower lobe pulmonary nodule with a branching afferent artery and dilated efferent vein defines the classical appearance of PAVM on chest radiography. The sensitivity of chest radiography is 60% to 70% with a 98% specificity when the classical findings are present [36]. The afferent and efferent vasculature and smaller PAVMs may be difficult to see on a single-view chest radiograph. Best diagnostic results are obtained when a 2-view chest radiograph, posteroanterior view, and lateral view is performed [37]. US Echocardiography Transesophageal There is no role for TEE as a standalone diagnostic tool in the evaluation of PAVMs. The usefulness of TEE in the context of PAVM is to rule out intracardiac shunts [38]. Its ability to demonstrate the interatrial septum and the insertion of the pulmonary veins into the left atrium is useful to evaluate the anatomical variations [39]. US Echocardiography Transesophageal With IV Contrast TEE with IV agitated saline contrast material is not routinely used to diagnose PAVM. Contrast-enhanced TEE may be helpful to locate a PAVM based on the excellent visualization of the 4 pulmonary venous ostia as veins drain into the left atrium.