Figure 4.

9-year-old female with genetically confirmed HHT, mild growth and developmental delay, presenting with dyspnea on exertion and chronic hypoxemia (baseline oxygen saturation of 60–80%) requiring supplemental oxygen. CT chest (not shown) showed diffuse PAVMs affecting all segments of both lungs. (a) Initial pulmonary angiogram of the left lung demonstrates diffuse PAVMs, most pronounced in the basal left lower lobe and lingula. (b) Final pulmonary angiogram of the left lung following peripheral-to-central embolization of the left lower lobe and lingula with implantation of 20 coils. (c) Final pulmonary angiogram of the contralateral right lung, performed 1 month after the left-sided embolization. Similar to the left lung, embolization was performed of the dominant PAVMs of the right lower lobe basilar segments. Despite the extensive embolization, the patient had no improvement in baseline oxygen saturation or functional status.