# Gastric Fundal Arteriovenous Malformation Presenting as Isolated Anemia and Dyspnea

## TL;DR

A rare case of a gastric AVM causing anemia and breathing issues is presented, highlighting the importance of considering unusual GI sources in unexplained symptoms.

## Contribution

This case report adds to the limited literature on gastric fundal AVMs and their atypical presentation.

## Key findings

- A 62-year-old male was diagnosed with a 2 mm bleeding gastric fundal AVM.
- The case emphasizes the need to consider Dieulafoy’s lesions in patients with unexplained anemia and cardiopulmonary symptoms.
- Literature review reveals variations in similar cases, underscoring diagnostic challenges.

## Abstract

Arteriovenous malformations (AVMs) are rare, abnormal connections between arteries and veins. This aberrant circulation leads to rapid arterial blood flow into the venous system, resulting in inadequate tissue oxygenation and increased intravascular pressure, which can predispose to rupture. AVMs are typically located in the brain or spinal cord; however, this case highlights an atypical location in the gastric fundus. Known as a Dieulafoy’s lesion, this gastrointestinal (GI) AVM represents a rare, clinically elusive diagnosis in the setting of an unclear or unexplained GI bleed. A 62-year-old male patient with a history of five coronary artery bypass grafts (CABG), paroxysmal atrial fibrillation (PAF), heart failure with preserved ejection fraction (HFpEF), hypertriglyceridemia, and prior GI bleed presented to the emergency room with complaints of shortness of breath, worse with exertion, over the last three weeks, with associated pre-syncopal episodes and palpitations. Laboratory work and esophagogastroduodenoscopy (EGD) confirmed a 2 mm bleeding gastric fundal AVM. Similar cases of this lesion have been reported in the literature, though variations exist, as will be described later in the discussion. This case underscores the importance of considering uncommon GI sources of bleeding, such as Dieulafoy's lesion, in patients with unexplained anemia and cardiopulmonary symptoms.