Incidental pulmonary arteriovenous malformation

A 13-year-old male presented after a traumatic fall, sustaining left upper extremity fractures. He was hypoxic (80%–90% on room air), requiring supplemental oxygen. Chest X-ray revealed a patchy right lower lobe opacity (Figure 1), prompting concern for pulmonary pathology. Computed tomography angiography (CTA) demonstrated a pulmonary arteriovenous malformation (AVM) with multiple engorged vessels draining into the right inferior pulmonary vein (Figure 2). The patient reported mild exertional dyspnea but denied chest pain, cyanosis, or syncope. Polycythemia (Hb 17.2 g/dL, Hct 51.2%) suggested chronic hypoxemia. Echocardiography confirmed right-to-left shunting, and genetic testing for hereditary hemorrhagic telangiectasia (HHT) was negative. The AVM remains under active surveillance. This case highlights the incidental discovery of a pulmonary AVM in a pediatric trauma patient, adding complexity to an otherwise trauma-focused clinical course. Though rare in children, pulmonary AVMs pose significant risks, including sedation-related complications, pulmonary hemorrhage, ischemic stroke, and heart failure. Chronic extra-cardiac AVMs can trigger compensatory mechanisms such as erythrocytosis, pulmonary vasodilation, and increased cardiac output, as seen in this patient. The unexpected finding necessitated a multidisciplinary approach involving cardiology, pulmonology, and genetics for safe management and evaluation of hereditary factors. The maternal history of cyanosis raised suspicion for HHT, an autosomal dominant disorder associated with AVMs in multiple organs.1 Early HHT identification is critical, as undiagnosed AVMs can lead to life-threatening complications. Systematic screening for HHT allows for early AVM detection, risk stratification, and preventive care, underscoring the importance of maintaining a broad differential in pediatric hypoxia cases. The authors declare no conflicts of interest. The authors obtained verbal informed consent, witnessed and documented in accordance with institutional guidelines, for publication of medical information and images. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.