PMC3644767_01
(a-b) -MRI -FLAIR axial images showing multiple chronic (arrow) infarcts bilateral hemispheres. (c-d) -Diffusion weighted image showing a few lesions (arrow) with reduced ADC (apparent diffusion coefficient) indicating that these infarcts are acute (<14 days)
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F1
She was evaluated with magnetic resonance imaging, which showed fluid attenuation inversion recovery (FLAIR) hyperintensities in the anterior and posterior circulation territories, some showing restricted diffusion suggestive of infarcts of varying ages [Figure 1a-d]. A review of her chest radiographs showed nodular opacities in both lung fields appearing contiguous with pulmonary artery shadows, raising a suspicion of PAVF [Figure 1a].
(a) -Chest radiograph AP view of patient showing rounded shadows (arrow),contiguous with right main pulmonary artery. (b) -CT- Pulmonary angiogram-Maximal intensity projection image showing multiple high volume arterio-venous fisulae with arterial feeders from superior, middle and inferior branch of right pulmonary artery and inferior branch of left pulmonary artery(arrows)
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F2
Her chest radiograph showed multiple shadows, which was initially interpreted as secondary to aspiration [Figure 2a]. Therefore, she underwent computed tomography (CT)-pulmonary angiogram, which showed multiple high-flow PAVF - a total of six in number - with arterial feeders from the right superior, middle and inferior as well as the left inferior pulmonary artery thus explaining her persisting hypoxemia and route for multiple cerebral embolism [Figure 2b].