A 32-year-old man with a history of recurrent epistaxis since childhood, microscopic hematuria, and a nodular lesion on chest radiograph presented with chest pain and dyspnea after chest trauma. Right hemothorax was detected on chest radiograph. Chest tube insertion was performed with an overall drainage of 700 mL of blood. Because of the persistence of a homogenous radio-opacity at the right lower hemithorax on the chest radiograph, he was referred to our pulmonary medicine department. On admission, physical examination showed dullness and absence of respiratory sounds at the lower third of right hemithorax. Laboratory findings showed mild anemia and hypoxemia of 57 mmHg. Chest radiograph showed a homogenous radio-opacity at the lower third of the right hemithorax, and a nodular lesion, 3.5 cm in diameter, projected over the upper border of the radio-opacity. No endobronchial lesion was observed under bronchoscopic examination. Computed tomography scan of the thorax showed a parenchymal nodular lesion at the right lower lobe and right pleural effusion.
Because the nodular lesion was interpreted as a possible arte-riovenous malformation (AVM), the diagnosis of Rendu-Osler-Weber disease was considered. The patient underwent a right lateral thoracotomy. Organized right subpulmonic hemothorax, pleural thickening, and an AVM at the anterobasal segment were detected. A pathologic report described AVM with recanalized thrombosis and multiple intraparenchymal and intrapleural telangiectasias, with evidence of rupture. Rupture of pleural telangiectasias is an extremely rare cause of hemothorax; however, it must be considered when a patient with a history of bleeding or an AVM presents with hemothorax.
© 1999 Lippincott Williams & Wilkins, Inc.