Pulmonary arteriovenous malformation in pregnancy: a case report and literature review

BACKGROUND: Pulmonary arteriovenous malformations (PAVMs) are rare vascular anomalies often linked to hereditary hemorrhagic telangiectasia (HHT). Pregnancy-related hemodynamic and hormonal changes may exacerbate PAVMs and lead to serious maternal and fetal complications. CASE: A 26-year-old multipara at 25 weeks’ gestation presented with fever, cough, progressive dyspnea and left chest pain. Imaging demonstrated bilateral PAVMs with a loculated left pleural effusion. She was managed conservatively (intercostal drainage, transfusion, thromboprophylaxis) and monitored closely. Embolization was discussed but deferred after multidisciplinary discussion because of insufficient finances and the patient’s clinical stability; elective cesarean section at 39 weeks resulted in a healthy newborn. The patient was referred to interventional radiology for planned postpartum embolization. OBJECTIVE: To report an unusual presentation of bilateral large PAVMs in pregnancy and to review the literature on diagnostic strategies, antenatal management (embolotherapy vs. surgery vs. conservative), and maternal–fetal outcomes. METHODS: We searched PubMed/MEDLINE, Embase and Scopus (Jan 1, 1997–Sep 30, 2025) using combinations of MeSH/keywords: “pulmonary arteriovenous malformation”, “PAVM”, “pulmonary AVM”, “pregnancy”, “pregnant”, “embolization”, “embolotherapy”, “hemothorax” (English, human). Case reports, case series and observational studies reporting PAVM in pregnancy were included; reviews and animal studies were excluded. Bibliographies of included articles were hand searched. RESULTS: A total of 21 published cases of PAVM in pregnancy were identified; after excluding the cases summarized in the earlier review up to 1997, we focused on 12 subsequent reports (Table 1). Dyspnea and chest pain were the most frequent presentations. Antenatal embolization was performed in several cases with generally favorable outcomes, though recanalization/persistence has been reported. No maternal deaths were reported among the cases included in our review. CONCLUSION: PAVM in pregnancy can present emergently and requires individualized, multidisciplinary management. Transcatheter embolization is the preferred treatment when feasible, but case-by-case decisions — accounting for clinical stability, gestation, and patient factors — are essential.