Pulmonary arterovenous malformation causing hemothorax in a pregnant woman without Osler-Weber-Rendu syndrome

Abstract

Pulmonary arteriovenous malformations (PAVMs), although most commonly congenital, are usually detected later in life.

Case report: We present a case of a 19-year-old woman with no previous history of AVM or telangiectasia, who presented dyspnea and hypoxia by massive left hemothorax in the 34th week of gestation. After emergent cesarean delivery, a chest computed tomography (CT) with i.v. contrast showed a likely 3 cm area of active contrast in left lower lung. Chest tube placement revealed about 2 liters of blood. The patient was subsequently found to have pulmonary AVM. A successful embolisation of AVM followed by lung atipic resection involving AVM and decortication for lung re-expansion were the treatments provided.

Conclusions: Women with known pulmonary AVM should be maximally treated prior to becoming pregnant, and the physician should be alert to complications of pulmonary AVM during pregnancy.

Keywords: Osler-Weber-Rendu syndrome; Pulmonary arteriovenous malformations; pregnant woman.

Figure 1

Chest X-ray showing left hemithorax opacification.

Figure 2

Computed tomography of the chest with I.V. contrast showing left-sided pleural effusion and a likely 3 cm area of active contrast.

Figure 3

Interventional radiologist-guided embolisation of the left pulmonary artery which was the culprit vessel.

Figure 4

Unexpandable lung showing after thoracotomy

Figure 5

Lung wedge resection involving AVM

Figure 6

Expanded lung after decortication XXX