https://doi.org/10.4081/ecj.2026.14832
A pulmonary arteriovenous shunt hypoxemia and recurrent bleeding in the emergency department: a case report
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Published: 8 April 2026
We report the case of a 62-year-old male with a long-standing history of Hereditary Hemorrhagic Telangiectasia (HHT, Rendu-Osler-Weber syndrome) complicated by multiple Pulmonary Arteriovenous Malformations (PAVMs), chronic anemia from recurrent gastrointestinal bleeding, and permanent atrial fibrillation. He presented to the Emergency Department (ED) with acute dyspnea and atrial fibrillation with rapid ventricular response. Despite high-flow oxygen therapy, severe hypoxemia persisted due to right-to-left shunt physiology. A prompt blood transfusion increased the oxygen delivery, contributing to transient clinical stabilization; however, the PaO2/FiO2 ratio remained severely reduced, confirming persistent impairment of oxygenation. After multidisciplinary evaluation, he underwent a successful embolization of one PAVMs, with overall clinical improvement. Because of high bleeding risk, long-term oral anticoagulation was avoided and left atrial appendage closure was proposed but declined by the patient. This case highlights the complexity of managing shunt hypoxia and anticoagulation in HHT patients with PAVMs presenting with acute dyspnea to the ED.
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CRediT authorship contribution
The authors contributed equally to the present paper.
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