Ruptured pulmonary arteriovenous malformation causing hemothorax during pregnancy: a case report

Pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly. During pregnancy, physiological hemodynamic changes and hormonal fluctuations substantially increase the risk of PAVM rupture. Spontaneous hemothorax secondary to ruptured PAVM is extremely uncommon and often presents with nonspecific manifestations, frequently resulting in misdiagnosis and delayed treatment. A 33-year-old woman at 31 + 6 weeks of gestation presented to the emergency department with a 30-minute history of sudden-onset left-sided chest pain radiating to the shoulder and back. Initial vital signs were relatively stable; however, progressive hypoxemia developed after admission. Following multidisciplinary consultation, using Triple-Rule-Out Computed Tomography Angiography (TRO-CTA) protocol demonstrated rupture of an aneurysmally dilated pulmonary arteriovenous malformation (PAVM) in the left lower lobe, complicated by hemothorax. Emergency transcatheter pulmonary artery embolization was successfully performed, resulting in rapid hemostasis and clinical stabilization. The pregnancy was subsequently continued, and a healthy neonate was delivered at 36 weeks of gestation. Pregnancy increases the risk of PAVM rupture and hemorrhage. Clinicians working in emergency settings should be aware of this rare but potentially fatal condition. Triple-Rule-Out Computed Tomography Angiography (TRO-CTA) is a valuable modality for both diagnosis and therapeutic planning, and transcatheter embolization represents an effective treatment option for this life-threatening complication.