Adverse events including air embolism are rare with TTCE occurring in <1% [46]. However, as a tool to measure the effectiveness of prior treatment, TTCE has low specificity and sensitivity. Variant 5: Asymptomatic with abnormal imaging on CT or chest radiography suggestive of PAVM. Next imaging study. Arteriography Pulmonary The real-time nature of pulmonary arteriography allows for high accuracy in delineating the angioarchitecture and detection of flow characteristics such as the early draining vein. In a study comparing the specificity of pulmonary arteriography and CTA, pulmonary arteriography was noted to have a higher specificity for detecting the angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the treatment procedure and does not have a standalone diagnostic role in detecting PAVM. An exception where pulmonary angiogram would be helpful as an initial diagnostic imaging tool is in a patient who is hemodynamically unstable with clinical suspicion of pulmonary hemorrhage from a PAVM [25]. CT Chest With IV Contrast Contrast-enhanced CT chest offers high spatial resolution and can detect the number, size, and distribution of PAVMs accurately. Contrast-enhanced CT provides similar diagnostic accuracy as noncontrast CT due to the high natural contrast inherent to pulmonary anatomy. IV contrast material administration adds a small risk of air embolism in patients with PAVM. Adequate precaution should be taken to prevent air embolism [10,26]. Cross- sectional anatomy displayed on CT chest with IV contrast is useful in treatment planning [10,27]. CT Chest Without and With IV Contrast There is limited data to support obtaining a CT chest with and without IV contrast in the setting of suspected PAVM.
Pulmonary Arteriovenous Malformation PAVM . Adverse events including air embolism are rare with TTCE occurring in <1% [46]. However, as a tool to measure the effectiveness of prior treatment, TTCE has low specificity and sensitivity. Variant 5: Asymptomatic with abnormal imaging on CT or chest radiography suggestive of PAVM. Next imaging study. Arteriography Pulmonary The real-time nature of pulmonary arteriography allows for high accuracy in delineating the angioarchitecture and detection of flow characteristics such as the early draining vein. In a study comparing the specificity of pulmonary arteriography and CTA, pulmonary arteriography was noted to have a higher specificity for detecting the angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the treatment procedure and does not have a standalone diagnostic role in detecting PAVM. An exception where pulmonary angiogram would be helpful as an initial diagnostic imaging tool is in a patient who is hemodynamically unstable with clinical suspicion of pulmonary hemorrhage from a PAVM [25]. CT Chest With IV Contrast Contrast-enhanced CT chest offers high spatial resolution and can detect the number, size, and distribution of PAVMs accurately. Contrast-enhanced CT provides similar diagnostic accuracy as noncontrast CT due to the high natural contrast inherent to pulmonary anatomy. IV contrast material administration adds a small risk of air embolism in patients with PAVM. Adequate precaution should be taken to prevent air embolism [10,26]. Cross- sectional anatomy displayed on CT chest with IV contrast is useful in treatment planning [10,27]. CT Chest Without and With IV Contrast There is limited data to support obtaining a CT chest with and without IV contrast in the setting of suspected PAVM.