What is causing this womans migraine, polycythemia, and hypoxemia?
The chest radiograph showed increased vascular markings on the right lung base. This suggested the possibility of pulmonary arteriovenous malformation (PAVM) in the right lower lobe. CT angiography revealed dilation and communication of the right lower lobe pulmonary arteries and veins, confirming the diagnosis of PAVM. Magnetic resonance angiography of the brain did not reveal any vascular anomalies. These results were discussed with the patient, and she was advised to stop smoking. The patient agreed to undergo pulmonary angiography with embolotherapy. Complex PAVMs of the subdivisions of the right lower lobe artery were embolized with 11 coils of multiple sizes (Figure 3). The patient’s SaO2222 improved from 90% to 98% by the end of the procedure. She tolerated the procedure well without complications. At 1- and 6-month follow-up, she reported complete resolution of migraine headaches.Discussion PAVM is an abnormal communication between a pulmonary artery and a pulmonary vein. These
