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  • Title: Follow-up interval for small untreated pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia.
    Author: Ryan DJ, O'Connor TM, Murphy MM, Brady AP.
    Journal: Clin Radiol; 2017 Mar; 72(3):236-241. PubMed ID: 28040200.
    Abstract:
    AIM: To investigate the natural history of untreated small (<3 mm) and microscopic pulmonary arteriovenous malformations (PAVMs) in hereditary haemorrhagic telangiectasia (HHT) in order to discern the optimal frequency of follow-up thoracic computed tomography (CT). MATERIALS AND METHODS: A retrospective analysis was performed on the follow-up data for definite and suspected HHT patients with untreated PAVMs. RESULTS: For small PAVMs in definite HHT (n=13), PAVM enlargement was identified in one patient (1/13, 7.7%) after 10.7 years follow-up and was successfully treated using transcatheter embolisation (TCE). For microscopic PAVMs in definite HHT (n=28), two patients (2/28, 7%) developed small asymptomatic PAVMs, which did not meet the size criteria for TCE after 6.8 years of follow-up. For small PAVMs in suspected HHT (n=5), feeding artery enlargement was seen in one patient (1/5, 20%) after 7.9 years, but again, this did not meet the size criteria for embolisation. No macroscopic PAVM development was identified after a median follow-up of 5.4 years in suspected HHT with microscopic PAVMs (n=20). CONCLUSION: For small and microscopic PAVMs in HHT, PAVM enlargement was found to be more infrequent than would be expected based on current guidelines; therefore, potentially challenging the current surveillance imaging recommendation of a repeat thoracic CT every 5 years.
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