*Review* **Approach to Pulmonary Arteriovenous Malformations: A Comprehensive Update**

#### **Shamaita Majumdar and Justin P. McWilliams \***

UCLA Department of Radiological Sciences, Los Angeles, CA 90095, USA; shamaitamajumdar@mednet.ucla.edu **\*** Correspondence: JuMcWilliams@mednet.ucla.edu; Tel.: +1-310-267-8773

Received: 26 April 2020; Accepted: 15 June 2020; Published: 19 June 2020

**Abstract:** Pulmonary arteriovenous malformations (PAVMs) are abnormal direct vascular communications between pulmonary arteries and veins which create high-flow right-to-left shunts. They are most frequently congenital, usually in the setting of hereditary hemorrhagic telangiectasia (HHT). PAVMs may be asymptomatic or present with a wide variety of clinical manifestations such as dyspnea, hypoxemia, or chest pain. Even when asymptomatic, presence of PAVMs increases patients' risk of serious, potentially preventable complications including stroke or brain abscess. Transcatheter embolotherapy is considered the gold standard for treatment of PAVMs. Though previous guidelines have been published regarding the managemen<sup>t</sup> of PAVMs, several aspects of PAVM screening and managemen<sup>t</sup> remain debated among the experts, suggesting the need for thorough reexamination of the current literature. The authors of this review present an updated approach to the diagnostic workup and managemen<sup>t</sup> of PAVMs, with an emphasis on areas of controversy, based on the latest literature and our institutional experience.

**Keywords:** pulmonary arteriovenous malformations; hereditary hemorrhagic telangiectasia; transcatheter embolotherapy; screening; guidelines
