Iatrogenic exacerbation of pulmonary arteriovenous malformation in a patient with benign metastasizing leiomyoma

We present a case of a middle-aged woman with known benign metastasizing leiomyoma presenting with pleural effusion. After ultrasound-guided drainage of the largest cyst was performed, the patient became hypoxemic. Chest computerized tomography (CT) showed a large tortuous vessel adjacent to the biggest cyst that had been drained. A 10-fold increase in the diameter of this vessel was noted when compared to CT scan performed 24 h before the procedure. A 20% right-to-left shunt was observed on nuclear medicine shunt study. To our knowledge, this is the first reported case of metastasizing leiomyoma with coexistent pulmonary arteriovenous malformation.