Isolated PAVM is rare condition and only a few cases of VATS (Video-Assisted Thoracoscopic Surgery) resection have been reported so far. Since the clinical course of PAVM is not entirely benign due to its possible progression and serious complications (paradoxical emboli, stroke, brain abscess, etc.), the most radical least invasive treatment should be chosen in all cases nowadays. Embolization may be incomplete and carries a risk of accidental systemic embolization, therefore surgical excision is the preferred method of choice. In cases of surgical resections, pulmonary parenchyma sparing techniques such as wedge resection and local excision by VATS is desirable, if possible. We present three patients who were admitted with asymptomatic pulmonary round shadow (umbra rotunda) for further investigation and treatment. We have performed two wedge resections by VATS and one segmentectomy via axillary thoracotomy. We wish to emphasize the importance of this disease to consider in differential diagnosis to avoid complications.

In case of some properly selected localised mainstem bronchial malignancies, such as young age and low grade malignancy, radical surgical interventions can be performed with long term survival preserving the whole lung due to special CBPs. Some such successful series and case reports (under 200 cases) can be found in the literature but the long-term survival data was not demonstrated in most publications. In Hungary there has not been any publications yet on such a successful series with long term survival. These results are remarkable within international standards.