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.

Pulmonary Arteriovenous Malformations (PAVMs) and Pregnancy: A Rare Case of Hemothorax and Review of the Literature

“…The treatment reserved to pAVMs was historically surgical resection of the anatomical-functional part of the lung involving the malformation. The endovascular technique of embolization has been recently accepted worldwide as mainstay of treatment and should be performed at time of diagnosis or when the following criteria are satisfied: progressive enlargement of a detected pAVM, paradoxical embolization, symptoms of hypoxemia and feeding vessels of 3 mm or larger [14]. A study about seven pregnant women with pAVMs treated with transcatheter embolotherapy (TCE) reported that this procedure is considered safe also when performed during pregnancy.…”

Acute onset shortness of breath in labour: haemothorax secondary to pulmonary arteriovenous malformation

“…There are multiple reports of pulmonary AVMs presenting in pregnancy [6,7,8], however presentation during labour is very unusual. All AVMs are likely to enlarge and are at higher risk of rupture during pregnancy due to the normal changes that occur in antenatal physiology.…”

Spontaneous Hemothorax by Pulmonary Arteriovenous Malformation during Pregnancy

“…Although the vast majority of pregnant women with PAVM are asymptomatic, when they present with symptoms such as hemoptysis, rupture, or hemothorax, the condition can be lethal [5]. Previous studies have reported the presence of PAVM during pregnancy due to complications, such as rupture, hemothorax, and hypovolemic shock [6][7][8][9].…”

“…In cases of massive hemothorax, surgery is the only choice [11]. TAE is also an effective treatment and should be performed at the time of diagnosis or when the following criteria are satisfied: progressive enlargement of a detected PAVM, paradoxical embolization, symptoms of hypoxemia, and feeding vessels of 3 mm or larger [6].…”

“…5 Previous studies have reported the presence of PAVM during pregnancy due to complications, such as rupture, hemothorax, and hypovolemic shock. [6][7][8][9] As early diagnosis and appropriate treatment are crucial for PAVMs, we herein present the case of a pregnant patient with life-threatening spontaneous tension hemothorax caused by a ruptured PAVM who was successfully treated with emergency thoracoscopic surgery.…”