Isolated pulmonary arteriovenous malformation in a patient presenting paradoxical cerebral embolism with patent foramen ovale

Abstract

We report a case of a 68-year-old woman who was diagnosed with isolated pulmonary arteriovenous malformation (PAVM) during follow-up of paradoxical cerebral embolism with patent foramen ovale (PFO). She developed acute cerebral infarction in left middle cerebral artery (MCA) territory with the occlusion of left MCA. Electrocardiogram showed a normal sinus rhythm. Transesophageal echocardiography revealed a PFO with right-to-left shunts, and Doppler ultrasound of venous system in the lower limbs revealed thrombosis in bilateral soleus veins. She was diagnosed with paradoxical cerebral embolism due to PFO, and started with an anticoagulant therapy. After 2 months, however, she developed upper gastrointestinal bleeding. The chest CT at the time revealed PAVM, and coil embolization was performed successfully. Although PAVM is rare and difficult to diagnose, we should take into account PAVM as a possible cause of cryptogenic stroke.