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Pulmonary arteriovenous fistulae (PAVF) are defined as the abnormal connections between pulmonary arterial and venous circulation bypassing the capillary bed [1]. PAVF might be a part of Osler-Weber-Rendu syndrome or can occur as an isolated anomaly [2]. The presentations of PAVF can range from asymptomatic abnormal shadow in the chest X-ray to the right to left shunt leading to cyanosis [3]. This shunt might result in hypoxemia manifesting with dyspnea, as well as paradoxical embolization, which can cause serious neurologic complications [3]. Case reportOur patient was a 16-year-old boy who presented with clubbing and cyanosis since five years of age. He did not have cyanosis since birth. There was neither history of recurrent lower respiratory tract, nor any history suggestive of congestive heart failure in the childhood. There was no feature of telengiectasia in the skin or mucous membrane. Clinical examination showed central cyanosis, pan-digital clubbing with SpO 2 of 84% in room

Indian patients with CC have more frequent and softer bowel movements compared to those in the USA suggesting significant differences in perception of CC in different geographic and cultural settings. QOL and economic impact related to constipation varies with geographic/cultural setting irrespective of other clinical and psychosomatic features.

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