Thoracoscopic surgery for multiple peripheral pulmonary arteriovenous fistulas.

A 37-year-old woman with dyspnea was referred to our department with the diagnosis of multiple bilateral pulmonary arteriovenous fistulas. Computed tomography of the chest showed nine fistulas in the right lung and four in the left lung. Because the fistulas were small and located peripherally, we chose thoracoscopic surgery instead of transcatheter pulmonary artery embolization. Intraoperatively, we identified four additional fistulas in the left lung. We resected 15 abnormal vessels and ligated two vessels during thoracoscopic surgery. Postoperatively, her dyspnea decreased and arterial blood oxygenation improved. Thoracoscopic surgery is a good treatment option for multiple small peripheral pulmonary arteriovenous fistulas.