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COPD exacerbation with acute hypercapnic respiratory failure — SCE Respiratory MCQ

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HardCOPDCOPD exacerbation with acute hypercapnic respiratory failureSCE Respiratory

CT performed after a cryptogenic cerebral abscess shows a technically accessible pulmonary arteriovenous malformation with a 2.2-mm feeding artery. Oxygen saturation is 96% and there is no dyspnoea. Which management principle follows the BTS statement?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Refer for specialist embolisation assessment despite the small feeding artery and mild physiology

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

A is correct. Any radiographically visible pulmonary arteriovenous malformation permits paradoxical emboli and should be referred to an experienced interventional service if technically feasible. BTS rejects the historical 3-mm feeding-artery rule because neurological complications, including cerebral abscess, occur with smaller lesions and are not predicted reliably by oxygen saturation or symptoms. Anticoagulation does not abolish the anatomic right-to-left conduit, surgery is not the default when embolisation is feasible, and oxygen may improve saturation but cannot close the malformation.

Reference: https://www.brit-thoracic.org.uk/document-library/clinical-statements/pavm/bts-clinical-statement-on-pulmonary-arteriovenous-malformations-pavms/