Gigantic Pulmonary Arteriovenous Malformation Presenting as Recurrent Lung Infection

The abnormal connection between pulmonary arterial and venous circulation is known as Pulmonary Arteriovenous Malformation (PAVM). It was first described by Churton in 1897. The presentation varies from incidental findings to shortness of breath, haemoptysis, chest pain, syncope and cyanosis. Patients with hereditary haemorrhagic telangiectasia are prone to develop PAVM. PAVMs are quite rare, the frequency ranges from 2-3 per 1,00,000 population. Treatment options include surgical intervention and embolisation, the former is now used seldom. The surgical intervention is more invasive than the percutaneous intervention procedure also known as embolotherapy or embolisation. In the present case, we encountered a rare case of a giant PAVM with 13 mm diameter (60.65x35.32 mm in dimensions), where patient presented with fever since two months and vomiting. Considering his symptoms, he was initially suspected as Coronavirus 2019 (COVID-19) positive. However, his Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was reported negative. It was decided to treat him with vascular plug embolisation. A 16 mm Ampletzer vascular plug II was deployed in such a way that it does not occlude the lower branches of Left Pulmonary Artery (LPA). After deploying the vascular plug, the patient was stable and tolerated the procedure well. He was discharged after two days of observation considering his haemodynamic stability.