Abstract
Background: Non Traumatic Hemothorax is a rare but grave cause of respiratory distress. AVMs increase in size and often present symptoms during Pregnancy.
Case Presentation: A healthy 31yr on her 34 week of pregnancy was admitted to the ER for acute pleuritic chest pain and orthopnea. The patient refused to undergo CT and was admitted with presumptive diagnosis of pulmonary embolism (PE).
Bedside Ultrasonography revealed a homogeneously echogenic effusion. CT Chest performed (fig 1). Pleural tap confirmed the diagnosis of hemothorax. Emergency C-section was performed with no complications. Chest drain insertion was followed by hypotension, quickly resolved with clamping of drain, vasopressors, and hemorrhagic shock treatment protocol. Exploratory Thoracotomy revealed a pulsing bleeding lesion of the associated lobe which was resected. Biopsy revealed Pulmonary AVM.
Figure 1.CT Chest: Large pleural effusion with high attenuation, passive atelectasis of left lung with a homogeneous, well-circumscribed, contrast enhancing lesion in the affected lung.
Discussion:
1.Pulmonary AVM is not uncommon, often presenting symptoms in pregnancy with chest symptoms mimicking PE.
2.Thoracic US can reliably help with Diagnosis
3.Hemodynamic collapse can follow chest drain insertion, so timing is vital.
- Copyright ©the authors 2016
