PMC6854255_01
Chest radiograph images during follow-up showed that the coils used in embolization of the pulmonary arteriovenous malformation of the left upper lobe became deformed. (a) 11 years before, (b) 4 years before, (c) 2 years before, (d) latest examination.
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During the follow-up, chest radiograph images showed that the coils in the left upper lobe became deformed (Figure 1).
(a) CT shows a cavity lesion including the coils in the left upper lobe (arrow) and ground-glass opacity around the cavity lesion (arrow heads). We suspected that the ground-glass opacity might represent the source of the bleeding. (b) CT performed 10 years earlier shows no cavity lesions.
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To evaluate the reason for hemoptysis, he underwent chest CT (Figure 2).
(a) Coils of the cavity lesion were confirmed (arrow), but pulmonary angiography showed no extravasation or hypervascular inflammatory parenchymal lesions. (b) Angiography of the left bronchial artery showed hypervascular inflammatory parenchymal lesions around the coils of the cavity lesion (arrows). Thus, the left bronchial artery was the vessel most likely to be responsible for the hemoptysis symptoms. (c) The microcatheter was advanced to the target branch of the left bronchial artery. Angiography showed hypervascular inflammatory parenchymal lesions around the coils of the cavity lesion (arrows) and bronchial-pulmonary artery shunt (arrow head). Embolization was performed using gelatin sponge. (d) Angiography of the left bronchial artery showed a complete occlusion of the target branch.
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Thereafter, angiography of both the left bronchial artery and pulmonary artery was performed to confirm which vessel was responsible for the symptoms (Figure 3).
Photograph of the resected left upper lobe. The cavity lesion including placed coils was confirmed (arrow), and it was connected to the bronchus (arrow head).
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To complete the treatment, lobectomy of the left upper lobe was performed (Figure 4).