Delayed presentation of a rare and complex multi-vessel pulmonary arteriovenous fistula following penetrating chest-wall trauma

The formation of a pulmonary arteriovenous malformation (PAVM) following penetrating chest trauma is a rare occurrence, often rapidly fatal or requiring emergency surgery. Even rarer still, is for the malformation to formed by an entangled and grossly tortuous network of multiple arteries and veins, with symptoms and eventual presentation to a medical facility taking place years after the initial injury. Without substantial literature available, and nil regarding instances of more than one involved artery and vein, we present the case of a complex left-sided PAVM, becoming symptomatic 15 years after a chest-wall stabbing. Clinical examination revealed hypoxia, tachycardia and an extracardiac bruit—prompting delineation with a computed tomography pulmonary angiogram and revealing the PAVM. Subsequent attempt at endovascular embolization was unsuccessful, though interrogation provided vital planning information for workup of urgent open-surgical ligation and resection. Surgery carries high morbidity and mortality, as does natural progression if left undealt.