Pulmonary arteriovenous malformation presenting as spontaneous haemothorax on transthoracic ultrasound

PAVM is a rare clinical disease which manifests in various presentations from asymptomatic in mild cases, to cyanosis, congestive heart failure and respiratory failure in severe cases.1 Spontaneous haemothorax as a life-threatening complication of PAVM is even rarer.1 2 However, a population-wide cancer screening programme using low-dose thoracic CT estimated the prevalence of PAVM to be 1 per 2600 individuals, which is more common than previously thought.3 Hence, clinicians should always have high index of suspicion for PAVM when dealing with a spontaneous haemothorax. CT thorax is generally considered the gold standard investigation for PAVM.4 However, colour Doppler ultrasound has recently been shown to be useful in a small series of patients in the diagnosis of PAVM.5 Besides, the mobility and point-of-care nature of ultrasound make it a useful bedside tool during initial assessment. [...]HHT cannot be reliably excluded on clinical grounds alone in patients presenting with multiple PAVMs alone without other clinical features suggesting of HHT.