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Variant: 1 Adult. Presenting with a transient ischemic attack, or seizures, or brain abscess, or altered sensorium. Chest radiography reveals a lung nodule. Suspected pulmonary arteriovenous malformation (PAVM). Next imaging study.

Procedure	Appropriateness Category
US echocardiography transthoracic with IV contrast	Usually Appropriate
MRA pulmonary arteries without and with IV contrast	Usually Appropriate
CT chest without IV contrast	Usually Appropriate
CTA pulmonary arteries with IV contrast	Usually Appropriate
US echocardiography transesophageal with IV contrast	May Be Appropriate
Arteriography pulmonary	May Be Appropriate
MRA chest without and with IV contrast	May Be Appropriate (Disagreement)
CT chest with IV contrast	May Be Appropriate
CT chest without and with IV contrast	May Be Appropriate (Disagreement)
CTA chest with IV contrast	May Be Appropriate (Disagreement)
US echocardiography transesophageal	Usually Not Appropriate
US echocardiography transthoracic resting	Usually Not Appropriate
Radiography chest	Usually Not Appropriate
MRA chest without IV contrast	Usually Not Appropriate
MRA pulmonary arteries without IV contrast	Usually Not Appropriate
Pertechnetate albumin pulmonary scan	Usually Not Appropriate

Variant: 2 Adult. Presenting with shortness of breath, or hemothorax, or hemoptysis. Patient has history of epistaxis and family history of hereditary hemorrhagic telangiectasia (HHT). Suspected PAVM. Initial imaging.

Procedure	Appropriateness Category
US echocardiography transthoracic with IV contrast	Usually Appropriate
MRA pulmonary arteries without and with IV contrast	Usually Appropriate
CT chest with IV contrast	Usually Appropriate
CT chest without IV contrast	Usually Appropriate
CTA chest with IV contrast	Usually Appropriate
CTA pulmonary arteries with IV contrast	Usually Appropriate
Arteriography pulmonary	May Be Appropriate
MRA chest without and with IV contrast	May Be Appropriate
CT chest without and with IV contrast	May Be Appropriate
US echocardiography transesophageal	Usually Not Appropriate
US echocardiography transesophageal with IV contrast	Usually Not Appropriate
US echocardiography transthoracic resting	Usually Not Appropriate
Radiography chest	Usually Not Appropriate
MRA chest without IV contrast	Usually Not Appropriate
MRA pulmonary arteries without IV contrast	Usually Not Appropriate
Pertechnetate albumin pulmonary scan	Usually Not Appropriate

Variant: 3 Adult. Asymptomatic with a family history of HHT and suspected PAVM. Initial imaging.

Procedure	Appropriateness Category
US echocardiography transthoracic with IV contrast	Usually Appropriate
MRA pulmonary arteries without and with IV contrast	Usually Appropriate
CT chest without IV contrast	Usually Appropriate
CTA chest with IV contrast	Usually Appropriate
CTA pulmonary arteries with IV contrast	Usually Appropriate
MRA chest without and with IV contrast	May Be Appropriate
CT chest with IV contrast	May Be Appropriate
CT chest without and with IV contrast	May Be Appropriate
US echocardiography transesophageal	Usually Not Appropriate
US echocardiography transesophageal with IV contrast	Usually Not Appropriate
US echocardiography transthoracic resting	Usually Not Appropriate
Radiography chest	Usually Not Appropriate
Arteriography pulmonary	Usually Not Appropriate
MRA chest without IV contrast	Usually Not Appropriate
MRA pulmonary arteries without IV contrast	Usually Not Appropriate
Pertechnetate albumin pulmonary scan	Usually Not Appropriate

Variant: 4 Adult. Presenting to establish care with a past history of a treated PAVM. Follow-up (surveillance) imaging following embolization of PAVM.

Procedure	Appropriateness Category
US echocardiography transthoracic with IV contrast	Usually Appropriate
MRA pulmonary arteries without and with IV contrast	Usually Appropriate
CT chest with IV contrast	Usually Appropriate
CT chest without and with IV contrast	Usually Appropriate
CT chest without IV contrast	Usually Appropriate
CTA chest with IV contrast	Usually Appropriate
CTA pulmonary arteries with IV contrast	Usually Appropriate
Arteriography pulmonary	May Be Appropriate
MRA chest without and with IV contrast	May Be Appropriate
US echocardiography transesophageal	Usually Not Appropriate
US echocardiography transesophageal with IV contrast	Usually Not Appropriate
US echocardiography transthoracic resting	Usually Not Appropriate
Radiography chest	Usually Not Appropriate
MRA chest without IV contrast	Usually Not Appropriate
MRA pulmonary arteries without IV contrast	Usually Not Appropriate

Variant: 5 Adult. Asymptomatic with abnormal imaging on CT or chest radiography suggestive of PAVM. Next imaging study.

Procedure	Appropriateness Category
US echocardiography transthoracic with IV contrast	Usually Appropriate
MRA pulmonary arteries without and with IV contrast	Usually Appropriate
CTA pulmonary arteries with IV contrast	Usually Appropriate
Arteriography pulmonary	May Be Appropriate
MRA chest without and with IV contrast	May Be Appropriate
MRA chest without IV contrast	May Be Appropriate
CT chest with IV contrast	May Be Appropriate (Disagreement)
CT chest without and with IV contrast	May Be Appropriate (Disagreement)
CT chest without IV contrast	May Be Appropriate
CTA chest with IV contrast	May Be Appropriate (Disagreement)
US echocardiography transesophageal	Usually Not Appropriate
US echocardiography transesophageal with IV contrast	Usually Not Appropriate
US echocardiography transthoracic resting	Usually Not Appropriate
MRA pulmonary arteries without IV contrast	Usually Not Appropriate

Anil K. Pillai, MD^a; Michael L. Steigner, MD^b; Ayaz Aghayev, MD^c; Sarah Ahmad, MD^d; Maros Ferencik, MD, PhD, MCR^e; Asha Kandathil, MD^f; David S. Kirsch, MD^g; Yoo Jin Lee, MD^h; Prashant Nagpal, MDⁱ; Kevin O'Neil, MD, MHA^j; Sasan Partovi, MD^k; Sha'Shonda Revels, MD^l; Beth Ripley, MD, PhD^m; Raymond R. Russell, MD, PhDⁿ; Sachin S. Saboo, MD^o; Andrew Tannenbaum, MD^p; Richard Thomas, MD, MBBS^q; Bryan J. Wells, MD^r; Hei Shun Yu, ^s; Sanjeeva P. Kalva, ^t.

Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when:

There are procedures that are equivalent alternatives (i.e., only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care)

There are complementary procedures (i.e., more than one procedure is ordered as a set or simultaneously wherein each procedure provides unique clinical information to effectively manage the patient’s care).

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please visit https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate	4, 5, or 6	The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)	5	The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate	1, 2, or 3	The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria^® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations
Relative Radiation Level*	Adult Effective Dose Estimate Range	Pediatric Effective Dose Estimate Range
O	0 mSv	0 mSv
☢	<0.1 mSv	<0.03 mSv
☢☢	0.1-1 mSv	0.03-0.3 mSv
☢☢☢	1-10 mSv	0.3-3 mSv
☢☢☢☢	10-30 mSv	3-10 mSv
☢☢☢☢☢	30-100 mSv	10-30 mSv
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”

1. [24008954] Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest. 2013;144(3):1033-1044.
2. [9700146] Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. [Review] [135 refs]. Am J Respir Crit Care Med. 158(2):643-61, 1998 Aug.
3. [7894484] McAllister KA, Grogg KM, Johnson DW, et al. Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet 1994;8:345-51.
4. [9245985] Berg JN, Gallione CJ, Stenzel TT, et al. The activin receptor-like kinase 1 gene: genomic structure and mutations in hereditary hemorrhagic telangiectasia type 2. Am J Hum Genet 1997;61:60-7.
5. [15031030] Gallione CJ, Repetto GM, Legius E, et al. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet 2004;363:852-9.
6. [10751092] Shovlin CL, Guttmacher AE, Buscarini E, et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 2000;91:66-7.
7. [12522784] Westermann CJ, Rosina AF, De Vries V, de Coteau PA. The prevalence and manifestations of hereditary hemorrhagic telangiectasia in the Afro-Caribbean population of the Netherlands Antilles: a family screening. Am J Med Genet A 2003;116A:324-8.
8. [30386957] Tellapuri S, Park HS, Kalva SP. Pulmonary arteriovenous malformations. [Review]. Int J Cardiovasc Imaging. 35(8):1421-1428, 2019 Aug.
9. [9095491] Esplin MS, Varner MW. Progression of pulmonary arteriovenous malformation during pregnancy: case report and review of the literature. [Review] [22 refs]. Obstet Gynecol Surv. 52(4):248-53, 1997 Apr.
10. [19553198] Faughnan ME, Palda VA, Garcia-Tsao G, et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 48(2):73-87, 2011 Feb.
11. [18385173] Shovlin CL, Tighe HC, Davies RJ, Gibbs JS, Jackson JE. Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure. Eur Respir J. 32(1):162-9, 2008 Jul.
12. [23912618] Woodward CS, Pyeritz RE, Chittams JL, Trerotola SO. Treated pulmonary arteriovenous malformations: patterns of persistence and associated retreatment success. Radiology. 269(3):919-26, 2013 Dec.
13. [31147241] Ratnani R, Sutphin PD, Koshti V, et al. Retrospective Comparison of Pulmonary Arteriovenous Malformation Embolization with the Polytetrafluoroethylene-Covered Nitinol Microvascular Plug, AMPLATZER Plug, and Coils in Patients with Hereditary Hemorrhagic Telangiectasia. J Vasc Interv Radiol. 30(7):1089-1097, 2019 Jul.
14. [20858807] Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol. 2010;195(4):837-845.
15. [33172103] de Gussem EM, Kroon S, Hosman AE, et al. Hereditary Hemorrhagic Telangiectasia (HHT) and Survival: The Importance of Systematic Screening and Treatment in HHT Centers of Excellence. J Clin Med 2020;9.
16. [22196589] Al-Saleh S, Dragulescu A, Manson D, et al. Utility of contrast echocardiography for pulmonary arteriovenous malformation screening in pediatric hereditary hemorrhagic telangiectasia. J Pediatr. 160(6):1039-43.e1, 2012 Jun.
17. [24813063] Karam C, Sellier J, Mansencal N, et al. Reliability of contrast echocardiography to rule out pulmonary arteriovenous malformations and avoid CT irradiation in pediatric patients with hereditary hemorrhagic telangiectasia. Echocardiography 2015;32:42-8.
18. [26953767] Inarejos Clemente EJ, Ratjen F, Manson DE. Utility of MDCT MIP Postprocessing Reconstruction Images in Children With Hereditary Hemorrhagic Telangiectasia. J Comput Assist Tomogr 2016;40:375-9.
19. [23344916] Kilburn-Toppin F, Arthurs OJ, Tasker AD, Set PA. Detection of pulmonary nodules at paediatric CT: maximum intensity projections and axial source images are complementary. Pediatr Radiol 2013;43:820-6.
20. [17456878] Peloschek P, Sailer J, Weber M, Herold CJ, Prokop M, Schaefer-Prokop C. Pulmonary nodules: sensitivity of maximum intensity projection versus that of volume rendering of 3D multidetector CT data. Radiology 2007;243:561-9.
21. [29528826] Katsura M, Sato J, Akahane M, Kunimatsu A, Abe O. Current and Novel Techniques for Metal Artifact Reduction at CT: Practical Guide for Radiologists. Radiographics 2018;38:450-61.
22. [29356855] Winklhofer S, Hinzpeter R, Stocker D, et al. Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy. Neuroradiology 2018;60:281-91.
23. [-3097783] American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2.
24. [18774307] Nawaz A, Litt HI, Stavropoulos SW, et al. Digital subtraction pulmonary arteriography versus multidetector CT in the detection of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2008;19(11):1582-1588.
25. [7956388] Ference BA, Shannon TM, White RI Jr, Zawin M, Burdge CM. Life-threatening pulmonary hemorrhage with pulmonary arteriovenous malformations and hereditary hemorrhagic telangiectasia. Chest. 106(5):1387-90, 1994 Nov.
26. [31875234] Muller-Hulsbeck S, Marques L, Maleux G, et al. CIRSE Standards of Practice on Diagnosis and Treatment of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2020;43:353-61.
27. [25032812] Circo S, Gossage JR. Pulmonary vascular complications of hereditary haemorrhagic telangiectasia. Curr Opin Pulm Med 2014;20:421-8.
28. [8184042] Remy J, Remy-Jardin M, Giraud F, Wattinne L. Angioarchitecture of pulmonary arteriovenous malformations: clinical utility of three-dimensional helical CT. Radiology. 1994;191(3):657-664.
29. [17116729] Brillet PY, Dumont P, Bouaziz N, et al. Pulmonary arteriovenous malformation treated with embolotherapy: systemic collateral supply at multidetector CT angiography after 2-20-year follow-up. Radiology 2007;242:267-76.
30. [16484354] Remy-Jardin M, Dumont P, Brillet PY, Dupuis P, Duhamel A, Remy J. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology. 239(2):576-85, 2006 May.
31. [32255688] Shin SM, Kim HK, Crotty EJ, Hammill AM, Wusik K, Kim DH. CT Angiography Findings of Pulmonary Arteriovenous Malformations in Children and Young Adults With Hereditary Hemorrhagic Telangiectasia. AJR Am J Roentgenol. 214(6):1369-1376, 2020 06.
32. [18356434] Schneider G, Uder M, Koehler M, et al. MR angiography for detection of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. AJR Am J Roentgenol. 2008;190(4):892-901.
33. [33202566] Van den Heuvel DAF, Post MC, Koot W, et al. Comparison of Contrast Enhanced Magnetic Resonance Angiography to Computed Tomography in Detecting Pulmonary Arteriovenous Malformations. J Clin Med 2020;9.
34. [3968579] Harding JA, Velchik MG. Pulmonary scintigraphy in a patient with multiple pulmonary arteriovenous malformations and pulmonary embolism. J Nucl Med 1985;26:151-4.
35. [4070672] Seto H, Futatsuya R, Kamei T, et al. Pulmonary arteriovenous malformation: radionuclide detection and quantification of right-to-left shunting. Radiat Med 1985;3:33-7.
36. [14742303] Cottin V, Plauchu H, Bayle JY, Barthelet M, Revel D, Cordier JF. Pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Am J Respir Crit Care Med. 2004;169(9):994-1000.
37. [29141890] Shovlin CL, Condliffe R, Donaldson JW, Kiely DG, Wort SJ, British Thoracic S. British Thoracic Society Clinical Statement on Pulmonary Arteriovenous Malformations. Thorax 2017;72:1154-63.
38. [8181373] Duch PM, Chandrasekaran K, Mulhern CB, Ross JJ, Jr., MacMillan RM. Transesophageal echocardiographic diagnosis of pulmonary arteriovenous malformation. Role of contrast and pulsed Doppler echocardiography. Chest 1994;105:1604-5.
39. [2212350] Mehta RH, Helmcke F, Nanda NC, Hsiung M, Pacifico AD, Hsu TL. Transesophageal Doppler color flow mapping assessment of atrial septal defect. J Am Coll Cardiol 1990;16:1010-6.
40. [12848887] Ahmed S, Nanda NC, Nekkanti R, Yousif AM. Contrast transesophageal echocardiographic detection of a pulmonary arteriovenous malformation draining into left lower pulmonary vein. Echocardiography 2003;20:391-4.
41. [19091794] Gazzaniga P, Buscarini E, Leandro G, et al. Contrast echocardiography for pulmonary arteriovenous malformations screening: does any bubble matter?. Eur J Echocardiogr. 10(4):513-8, 2009 Jun.
42. [1746435] Barzilai B, Waggoner AD, Spessert C, Picus D, Goodenberger D. Two-dimensional contrast echocardiography in the detection and follow-up of congenital pulmonary arteriovenous malformations. Am J Cardiol 1991;68:1507-10.
43. [17317734] Zukotynski K, Chan RP, Chow CM, Cohen JH, Faughnan ME. Contrast echocardiography grading predicts pulmonary arteriovenous malformations on CT. Chest. 2007;132(1):18-23.
44. [34322523] Deng Y, Huang X, Wang G, et al. Applicability of Transthoracic Contrast Echocardiography for the Diagnosis and Treatment of Idiopathic Pulmonary Arteriovenous Malformations. Front Cardiovasc Med 2021;8:656702.
45. [23429940] Velthuis S, Buscarini E, van Gent MW, et al. Grade of pulmonary right-to-left shunt on contrast echocardiography and cerebral complications: a striking association. Chest. 2013;144(2):542-548.
46. [19276509] Bhatia V, Arora P, Parida AK, Singh G, Kaul U. Air travel and pulmonary embolism: "economy class syndrome". Indian Heart J 2008;60:608-11.
47. [26724660] Belanger C, Chartrand-Lefebvre C, Soulez G, et al. Pulmonary arteriovenous malformation (PAVM) reperfusion after percutaneous embolization: Sensitivity and specificity of non-enhanced CT. Eur J Radiol. 85(1):150-157, 2016 Jan.
48. [16371535] Milic A, Chan RP, Cohen JH, Faughnan ME. Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol 2005;16:1675-83.
49. [16415131] Pollak JS, Saluja S, Thabet A, Henderson KJ, Denbow N, White RI Jr. Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol. 17(1):35-44; quiz 45, 2006 Jan.
50. [14963181] Prasad V, Chan RP, Faughnan ME. Embolotherapy of pulmonary arteriovenous malformations: efficacy of platinum versus stainless steel coils. J Vasc Interv Radiol. 15(2 Pt 1):153-60, 2004 Feb.
51. [1535899] Remy J, Remy-Jardin M, Wattinne L, Deffontaines C. Pulmonary arteriovenous malformations: evaluation with CT of the chest before and after treatment. Radiology. 182(3):809-16, 1992 Mar.
52. [33459902] Hong J, Lee SY, Cha JG, et al. Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT. CVIR Endovasc 2021;4:16.
53. [26560716] Gamondes D, Si-Mohamed S, Cottin V, et al. Vein Diameter on Unenhanced Multidetector CT Predicts Reperfusion of Pulmonary Arteriovenous Malformation after Embolotherapy. Eur Radiol. 26(8):2723-9, 2016 Aug.
54. [35064274] Zheng H, Yang M, Jia Y, et al. A Novel Subtraction Method to Reduce Metal Artifacts of Cerebral Aneurysm Embolism Coils. Clin Neuroradiol 2022;32:687-94.
55. [33449178] Shimohira M, Kiyosue H, Osuga K, et al. Location of embolization affects patency after coil embolization for pulmonary arteriovenous malformations: importance of time-resolved magnetic resonance angiography for diagnosis of patency. Eur Radiol 2021;31:5409-20.
56. [25012936] Kawai T, Shimohira M, Kan H, et al. Feasibility of time-resolved MR angiography for detecting recanalization of pulmonary arteriovenous malformations treated with embolization with platinum coils. J Vasc Interv Radiol. 25(9):1339-47, 2014 Sep.
57. [35914744] Hong J, Lee SY, Lim JK, et al. Feasibility of Single-Shot Whole Thoracic Time-Resolved MR Angiography to Evaluate Patients with Multiple Pulmonary Arteriovenous Malformations. Korean J Radiol 2022;23:794-802.
58. [25851199] Shimohira M, Kawai T, Hashizume T, et al. Reperfusion Rates of Pulmonary Arteriovenous Malformations after Coil Embolization: Evaluation with Time-Resolved MR Angiography or Pulmonary Angiography. J Vasc Interv Radiol. 26(6):856-864.e1, 2015 Jun.
59. [-3128692] American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination

Pulmonary Arteriovenous Malformation (PAVM)