Abstract
The patient, a 28-year-old woman at 34 weeks of gestation, was admitted our hospital because of chest pain. Right pleural effusion was detected on a chest X-ray study, and thoracentesis revealed hemorrhagic pleural effusion. Since rupture of a pulmonary arteriovenous fistula was suspected based on a chest CT study, surgery was immediately performed. We considered that she presented with hemothorax but her hemodynamics was stable and that the fetus' respiratory function would be sufficiently mature because it was older than 34 weeks. After delivering the fetus by Caesarean section in cooperation with a gynecologist, video-assisted thoracic surgery was performed. We confirmed massive hemorrhagic pleural effusion and pulsatile bleeding from the arteriovenous fistula in the thoracic cavity. A wedge resection including the pulmonary arteriovenous fistula was performed. The postoperative course was good and both mother and her child are in good health. A pulmonary arteriovenous fistula can cause severe complications during pregnancy, because circulating blood volume increases and blood vessels dilate due to an increase in progesterone. In instances in which treatment is required, we should take the states of both the mother and her fetus into account.
