2018 Volume 32 Issue 4 Pages 487-491
A 70-year-old woman was referred to our hospital because of an abnormal shadow on a chest radiograph and hypoxemia. Computed tomography of the chest revealed an enhanced solitary lung nodule which was connected with linear structures suggestive of feeding arteries and a drainage vein in the left upper lobe inferior lingular segment. A total of four afferent feeding arteries originated from different segmental pulmonary arteries (A3, A4, A5, and A8). We made a preoperative diagnosis of complex-type pulmonary arteriovenous fistula (PAVF). Percutaneous image-guided embolotherapy was considered to be inapplicable, so we performed pulmonary resection of the left upper lobe by video-assisted thoracoscopic surgery (VATS). The right-to-left shunt fraction and partial pressure of arterial oxygen (PaO2) were markedly improved after surgery (31.4 to 9.5% and 50.2 to 89.7 mmHg respectively). Here, we describe the case of an elderly patient with complex-type PAVF treated with VATS.
