Pulmonary angiogram detected only 77% to 80% of the PAVMs that were seen on MRA. In their study, Pulmonary Arteriovenous Malformation (PAVM) the majority of the PAVMs not detected by pulmonary angiogram were <5 mm in size. The size criterion was defined as the size of the PAVM itself and not of the feeding artery. A more recent study by Van den Heuvel et al [33] investigated the sensitivity of contrast-enhanced MRA for detection of PAVMs with a feeding artery >2 cm in children and young adults. 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]. The role of chest radiography in the diagnosis of a suspected PAVM is limited due to its poor sensitivity.
Pulmonary Arteriovenous Malformation PAVM . Pulmonary angiogram detected only 77% to 80% of the PAVMs that were seen on MRA. In their study, Pulmonary Arteriovenous Malformation (PAVM) the majority of the PAVMs not detected by pulmonary angiogram were <5 mm in size. The size criterion was defined as the size of the PAVM itself and not of the feeding artery. A more recent study by Van den Heuvel et al [33] investigated the sensitivity of contrast-enhanced MRA for detection of PAVMs with a feeding artery >2 cm in children and young adults. 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]. The role of chest radiography in the diagnosis of a suspected PAVM is limited due to its poor sensitivity.