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. US Echocardiography Transesophageal There is no role for ultrasound (US) transesophageal echocardiography (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. Based on the visualization of contrast material emanating from a particular pulmonary vein, the location of the PAVM in that venous territory can be confirmed [38,40]. In the presence of multiple PAVMs, the usefulness of this imaging modality in identifying the location of the PAVMs is limited. US Echocardiography Transthoracic Resting There is no role for transthoracic echocardiography (TTE) in the resting phase for the evaluation of PAVM. It does allow evaluation of intracardiac shunts and assessment of cardiac function [38]. US Echocardiography Transthoracic With IV Contrast TTCE is an essential diagnostic test for patients suspected of having a PAVM. TTCE with agitated saline has a 98% to 99% sensitivity and a 67% to 91% specificity for detecting PAVMs [41].
Pulmonary Arteriovenous Malformation PAVM . 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. US Echocardiography Transesophageal There is no role for ultrasound (US) transesophageal echocardiography (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. Based on the visualization of contrast material emanating from a particular pulmonary vein, the location of the PAVM in that venous territory can be confirmed [38,40]. In the presence of multiple PAVMs, the usefulness of this imaging modality in identifying the location of the PAVMs is limited. US Echocardiography Transthoracic Resting There is no role for transthoracic echocardiography (TTE) in the resting phase for the evaluation of PAVM. It does allow evaluation of intracardiac shunts and assessment of cardiac function [38]. US Echocardiography Transthoracic With IV Contrast TTCE is an essential diagnostic test for patients suspected of having a PAVM. TTCE with agitated saline has a 98% to 99% sensitivity and a 67% to 91% specificity for detecting PAVMs [41].