Reccuring Strokes due to an Arterio-Venous Fistula in the Pulmonary Circulation

A   67 year old female patient with history of smoking, and hypertension with recurring strokes was investigated for any source  of  cardiac  emboli. Although none pathology involving atrial septum was detected with trensesophageal echocardiography, massive  inflow  of microbubbles to the left atrium were suggestive of another type of right to left communication. CT-angiography  of pulmonary circulation  evealed  an arterio-venous  fistula  between  the  right pulmonary  artery and the  right  superior pulmonary vein.