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Pulmonary arteriovenous malformation — SCE Respiratory MCQ

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HardPulmonary Vascular DiseasePulmonary arteriovenous malformationSCE Respiratory

A 29-year-old man has hereditary haemorrhagic telangiectasia and exertional dyspnoea. CT pulmonary angiography shows a right lower-lobe pulmonary arteriovenous malformation with feeding artery diameter 4 mm. Oxygen saturation is 92% on air and he has a history of cerebral abscess. What is the most appropriate management?

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Correct answer: C — Transcatheter embolisation of the pulmonary AVM

The best answer is “Transcatheter embolisation of the pulmonary AVM”. Transcatheter embolisation of the pulmonary AVM is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Long-term prednisolone, with clinical reassessment”, “Observation in the absence of follow-up”, “Pleurodesis, after specialist assessment”, “Pulmonary endarterectomy, with clinical reassessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for home oxygen: https://thorax.bmj.com/content/70/Suppl_1/i1