Incidental Diagnosis of Hereditary Hemorrhagic Telangiectasia Following Perioperative Hypoxemia in a 4‐Year‐Old Child
Chun‐Chen Sun, Chen‐Hsiu ChenABSTRACT
A 4‐year‐old girl with no prior respiratory history developed refractory intraoperative hypoxemia during elective dental surgery under general anaesthesia. Despite 100% inspired oxygen and systematic exclusion of all conventional causes of desaturation, pulse oximetry (SpO 2 ) failed to exceed 94%. Postoperative contrast‐enhanced chest computed tomography identified a 2.01‐cm pulmonary arteriovenous malformation (PAVM) in the right lung, and subsequent molecular genetic testing confirmed hereditary hemorrhagic telangiectasia (HHT). The patient was discharged with baseline SpO 2 of 85%–95% on room air and established on long‐term paediatric pulmonary follow‐up. This case highlights that PAVMs associated with HHT can manifest as unexplained perioperative hypoxemia in asymptomatic children, and that general anaesthesia with positive pressure ventilation may unmask previously compensated right‐to‐left shunting. Early recognition enables appropriate perioperative management and timely HHT surveillance.