PMC9280100_01
(a) Electrocardiogram with prominent R in the anterior chest leads with ST-segment depression suggestive of right ventricular strain. (b) Parasternal short-axis view on echocardiogram showing dilated right ventricle with a flattened interventricular septum. (c) Spectral Doppler showing right ventricular systolic pressure gradient of 70 mm of Hg
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F1
The electrocardiogram (ECG) had a right-axis deviation and RV hypertrophy with strain pattern [Figure 1a]. Transthoracic echocardiogram demonstrated enlargement of the right atrium and right ventricle with normal function, mild tricuspid regurgitation, and dilated pulmonary arteries [Figure 1b]. The estimated PA systolic pressure was elevated at 80 mmHg [Figure 1c].
(a) Computed tomography topogram image showing lobulated oval density in the right lower zone paracardiac region (white arrow). Another larger ovoid density is seen in the left retrocardiac region (dashed arrow). (b) Computed tomography pulmonary angiogram image showing the typical appearance of arteriovenous malformation, with a large feeding vessel arising from the pulmonary artery (yellow arrow) and an adjacent draining vein (blue arrow), entering and exiting the malformation arteriovenous malformation (red arrow). (c) Coronal maximum intensity projection contrast-enhanced computed tomography images depicting large simple arteriovenous malformations (red arrows) with feeding artery from the right lower lobe segmental pulmonary artery (yellow arrow) and draining through the right inferior pulmonary vein (blue arrow). (d) Computed tomography volume-rendered image showing the bilateral arteriovenous malformation, with a large feeding vessel arising from the pulmonary artery (white arrow) entering the malformation arteriovenous malformation
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F2
Computed tomography (CT) angiography showed dilated main PA, dilated right-sided chambers, and large PAVM in the right middle lobe and left lower lobe of the lung [Figure 2a-d].
(a) Axial contrast-enhanced early arterial phase computed tomography abdomen image depicts inhomogeneous attenuating pattern within the liver parenchyma with multiple telangiectases (red arrow), large confluent vascular mass (blue arrow). (b) Computed tomography abdomen depicting multiple telangiectases (red arrow) and dilated hepatic artery (yellow arrow)
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F3
The abdominal CT demonstrated a dilated celiac artery and its branches with multiple tiny arteriovenous malformations, confluent vascular masses, and a few cysts [Figure 3a and b].