A case report of massive hemothorax in pregnant woman with a pulmonary arteriovenous malformation: sometimes thoracotomy is the only option?

Background: Pulmonary arteriovenous malformations (pAVMs) are vascular abnormalities whose origin may be due to genetic or acquired causes. Their rupture can be caused by several or precipitating factors, such as trauma, infection, or conditions associated with changes of the cardio-vascular system, such as pregnancy. The most fearsome, but also rare, complication associated with the rupture of pAVMs is massive haemothorax. Embolization is the treatment of choice, but when endovascular management is not feasible, surgical approaches include wedge resection, segmentectomy, lobectomy and pneumonectomy, also performed by video-assisted thoracoscopic surgery (VATS). However, the treatment of these abnormalities and their associated complications depends on the severity of the clinical scenario, the patient features and the characteristics of the malformations. Case Description: We report the case of a 31-year-old black female 24 weeks pregnant with massive haemothorax due to the rupture of a pAVM. After an immediate chest computed tomography (CT) scan the patient underwent surgery with open pulmonary resection. Postoperative course was uneventful and the patient brought her pregnancy to term with a cesarean section. Conclusions: Pregnancy increases the risk of complications in pAVMs and clinicians should be aware of this rare anomaly in emergency setting. The surgical approach must be weighed against the risks to the mother and fetus.