Jan Henzel1, MD; Piotr N. Rudziński1, MD; Ilona Michałowska2, MD, PhD; Barbara Lubiszewska1, MD, PhD; Marcin Demkow1, MD, PhD
1. Department of Coronary Artery and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland; 2. Department of Radiology, Institute of Cardiology, Warsaw, Poland
An 83-year-old female with a history of two coronary artery bypass graft surgeries and multiple comorbidities presented with aggravation of chronic heart failure accompanied by central cyanosis and nail clubbing. Pulse oximetry was 80-85% on room air, 95% on supplemental oxygen. Chest X-ray showed a large mass in the posterobasal area of the left lung (Panel A, arrow). Common states such as pneumonia or lung cancer were initially suspected, yet, surprisingly, contrast-enhanced computed tomography revealed a giant, 52 mm pulmonary arteriovenous fistula (Panel B, Panel E, #). The structure derived from the segmental branch of the left pulmonary artery (Panel B, ...