# From Scar to Shunt: Incidental Discovery of Pulmonary Arteriovenous Malformation in a Healthy Adult Trauma Patient

## TL;DR

A healthy adult trauma patient was found to have a large lung malformation that caused breathing issues but showed no symptoms, requiring two procedures for full treatment.

## Contribution

Highlights the potential for asymptomatic, severe pulmonary arteriovenous malformations in trauma patients and the need for staged interventions.

## Key findings

- A 59-year-old man had a large PAVM discovered incidentally during trauma evaluation.
- Initial embolization reduced but did not fully resolve the shunt, requiring a second procedure.
- PAVMs can be asymptomatic despite severe hypoxemia and require careful follow-up and genetic evaluation.

## Abstract

Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies that create right-to-left shunts, predisposing patients to hypoxemia, paradoxical emboli, and cerebral abscess. While often congenital and associated with hereditary hemorrhagic telangiectasia (HHT), they may also be acquired. We describe the case of a 59-year-old Hispanic man who was incidentally found to have a large left lower lobe PAVM with a 1.1 cm feeding artery during evaluation for traumatic injuries. Despite severe hypoxemic respiratory failure, he had no respiratory symptoms or distress. Initial embolization reduced but did not eliminate the shunt, necessitating a second procedure that achieved complete closure. This case reinforces the importance of recognizing that PAVMs can remain clinically silent despite severe physiologic burden and often require staged management when large feeding arteries are involved. Vigilant follow-up and genetic evaluation remain essential to preventing long-term complications.