Iatrogenic Chest Wall Arteriovenous Malformation Following Chest Tube Placement: A Case Report

Arteriovenous malformations (AVMs) are vascular anomalies characterized by direct arterial-to-venous connections that bypass the capillary system. Chest‑wall AVMs are rare, with only few reports of iatrogenic AVMs following chest‑tube placement. We describe a large, symptomatic chest‑wall AVM developing at the site of prior chest‑tube insertion, highlighting diagnostic, operative, and follow‑up strategies. We present a case of a 37-year-old male patient with a large, symptomatic chest wall AVM centered around a scar from a prior chest tube placement. A thorough preoperative assessment was conducted, including imaging and a biopsy, which confirmed the diagnosis. Given the lesion's hypervascularity, the risk of significant bleeding during biopsy was carefully considered, and the procedure was performed with interventional radiology support to minimize complications. The decision was made to proceed with targeted embolization of the lesion, significantly reducing intraoperative hemorrhage risk and facilitating safe subsequent surgical intervention. A combined open and thoracoscopic surgical approach led to successful resection of the lesion. This report highlights that although the majority of AVMs are congenital, there is a significant potential for iatrogenic AVM formation, particularly following invasive procedures such as chest tube placement. This case underscores the importance of a multidisciplinary approach in diagnosing and managing complex vascular anomalies and highlights lessons learned in careful chest tube placement to avoid vascular injury.