Polypoid pulmonary arteriovenous malformation causing hemothorax treated with thoracoscopic wedge resection

Area of Science:

• Cardiology
• Thoracic Surgery
• Radiology

Background:

• Pulmonary arteriovenous malformations (PAVMs) pose risks of serious complications like hemothorax.
• Catheter embolization is first-line but has a recurrence rate of 5-25%.
• Minimally invasive thoracic surgery is emerging as a definitive treatment option.

Purpose of the Study:

• To describe a case of hemothorax caused by a peripheral PAVM.
• To evaluate the safety and efficacy of video-assisted thoracoscopic surgery (VATS) for PAVM treatment.
• To highlight VATS as a definitive surgical option for specific PAVM presentations.

Main Methods:

• A 64-year-old male with a history of brain abscess presented with hemothorax.
• Chest CT and 3D CT identified a 15-mm PAVM protruding into the pleural cavity.
• The patient underwent successful VATS with wedge resection of the affected lung lobe.

Main Results:

• The PAVM was successfully resected via VATS without complications.
• The patient remained asymptomatic with a 1-year follow-up.
• Preoperative MDCT and 3DCT accurately identified the PAVM's pleural protrusion.

Conclusions:

• PAVMs protruding into the pleural cavity can cause hemothorax.
• Surgical wedge resection via VATS is a feasible and potentially safer definitive treatment.
• VATS is particularly advantageous for PAVMs located near the visceral pleura.