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Course: A Female Patient With Recurrent Headache and Syncope

CME Credits: 1.00

Released: 2024-01-17

A female patient in her 30s presented with a history of hypoxia, syncope, and headaches for 5 years. Physical examination revealed cyanotic lips, clubbed fingers, and no heart murmur. A shrinking cerebellar abscess was treated with antibiotics and followed up by brain magnetic resonance imaging for 5 years. The initial diagnosis was anomalous pulmonary venous connection or patent foramen ovale. An agitated saline study showed a late passage of bubbles after 5 heartbeats. Computed tomography pulmonary angiography (CTPA) demonstrated bilateral and multiple pulmonary arteriovenous fistulas (PAVFs) (Figure, A).1


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