Transcatheter Embolotherapy of Maternal Pulmonary Arteriovenous Malformation During Twin Pregnancy With Hereditary Hemorrhagic Telangiectasia: A Case Report

Hereditary hemorrhagic telangiectasia (HHT) is a multiple-organ disease. Herein, we report a case of rupture of an undiagnosed pulmonary arteriovenous malformation (PAVM) during pregnancy in which good outcomes for both mother and children were achieved with transcatheter embolization. The patient was a pregnant 32-year-old Pashtun woman, G4P3, with a history of cesarean section. She had undergone pregnancy checkups at our hospital for a dichorionic diamniotic twin pregnancy. In gestational week 20, the patient experienced loss of consciousness at home and was transported by ambulance to our hospital. Her Glasgow Coma Scale score was 9 (E2V2M5) and her blood pressure was 57/27 mmHg. Blood test results showed severe anemia; right atelectasis and mediastinal shift were shown on chest radiography. Contrast-enhanced chest computed tomography revealed right hemothorax and a single pulmonary arteriovenous malformation measuring 35 mm in the middle lobe of the right lung. The patient was diagnosed with hemothorax due to rupture of the right PAVM. Emergency transcatheter embolization was performed, disappearance of the arteriovenous malformation was confirmed, and hemostasis was achieved. Recurrent epistaxis and telangiectasias on the tongue, buccal mucosa, and nasal cavity were noted, and the patient was diagnosed with HHT. An abdominal cesarean section was performed due to the low-lying placenta and right hydronephrosis. Two male neonates were delivered: one weighed 1988 g and the other 2166 g. Both mother and infants progressed well. This case illustrates how unrecognized HHT can lead to catastrophic PAVM rupture during pregnancy and emphasizes the lifesaving value of early diagnosis and prompt endovascular intervention. In addition, it highlights the critical importance of pre‑pregnancy screening for HHT to prevent life‑threatening complications.