Spontaneous hemothorax in pregnant patient with pulmonary arteriovenous malformation

We present a case of a 34-year-old pregnant patient at 26 weeks' gestation by in vitro fertilization with past medical history of hypertension and infertility who presented to the hospital with abdominal pain. The patient stated her pain was in her left upper quadrant. The morning before arriving to the hospital the patient stated she woke up at 0300 with increasingly severe pain in the same area. A computed tomography angiogram of the chest demonstrated a left-sided pulmonary arteriovenous malformation with adjacent complex left effusion on chest suspicious for a hemothorax. The hemothorax was thought to be brought about by rupture of the arteriovenous malformation with likely intermittent small volume hemorrhages into the pleural space. Thoracic Surgery and Interventional radiology (IR) were each consulted for management of the arteriovenous malformation. Due to the patient’s stable hemodynamic status and concern that an invasive procedure might enable a larger rupture and more substantial hemorrhage, the decision was made for embolization of the arteriovenous malformation.