A rare case of hemothorax due to rupture of an arteriovenous fistula: successful treatment by enucleation]

Hemothorax due to a rupture in an arteriovenous fistula is rare. We report a case in a 26-year-old woman who presented with continuous right chest pain. On admission, chest radiography revealed a nodular shadow in the right lower lung field with right pleural effusion. The pleural effusion aspirated was blood, suggesting a hemothorax due to the rupture of a pulmonary arteriovenous fistula. The shunt between A 8 and V 8 was confirmed in pulmonary arteriograms. A photomicrograph of the resected specimen showed a dilated arteriovenous fistula, part of whose inner wall was abnormally thin. The pleural wall surrounding the fistula was hypertrophic in parts, suggesting possible repetitive inflammation related with the rupture. Although transcatheter embolization is useful in the treatment of arteriovenous fistulae, it is technically difficult, and cases of fatal complications have been reported. While surgical resection is the most reliable treatment available, the present patient was already at high risk of dying. Accordingly, we chose to perform enucleation, and this was successful.