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A 3 year old boy was admitted for investigation of generalised cyanosis (arterial oxygen saturation to 81%), associated with abnormal density on the left upper lung field (upper panel, middle) and normal cardiac examination.
Lung scanning with 99 Tc-albumin showed a large perfusion defect in the same region and presence of radiotracer in the systemic circulation. Chest computed tomography (lower panel, middle) and magnetic resonance imaging (upper panel, right) showed a huge hypervascular mass in the left hemi thorax compatible with pulmonary vascular fistulas (arrows); smaller additional vascular nodules were present in the right lung. The diagnosis of pulmonary vascular fistulas was confirmed by angiography (lower panel, right; arrow).
Following successful lobotomy and embolisation of the right sided fistulae, the child improved significantly and was seen five months later with arterial oxygen saturation to 91%.
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