High importance
Aug 25, 2026
To report a rare case of ruptured pulmonary arteriovenous malformation (PAVM) during pregnancy that resulted in hemothorax and to emphasize the need for awareness and proper diagnostic modalities in emergency settings.
The case involved a 33-year-old pregnant woman who experienced sudden chest pain and was diagnosed with a ruptured PAVM using Triple-Rule-Out Computed Tomography Angiography (TRO-CTA), followed by emergency transcatheter pulmonary artery embolization for treatment.
The successful embolization led to rapid hemostasis and stabilization of the patient. The pregnancy continued, resulting in the delivery of a healthy neonate at 36 weeks.
The case is a singular report and may not be widely generalizable. Further studies are necessary to understand the risk factors and management of PAVMs in pregnant patients.
This case highlights the increased risk of PAVM rupture during pregnancy and the importance of prompt recognition and intervention to prevent fatal outcomes.
BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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.