PMC7554207_01
The thin wire. The detachable coil in length 25 cm (DETACH DCS Coil, Cook Japan, Tokyo, Japan). Originally, distal end of the coil shaped J. There is no deformation, disconnection, or un-raveling. White arrowhead: proximal end of coil. Black arrowhead: distal end of coil.
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fig1
A 44-year-old Japanese woman presented with strong dry cough producing a thin wire (Fig. 1).
Angiography of pulmonary arteriovenous malformations. Pre-embolization angiography of the right pulmonary artery. Four pulmonary arteriovenous malformations (PAVMs) was detected in two segments, right S9 (white arrow and white arrowhead) and right S6 (black arrow and black arrowhead). As for the largest PAVM in right S9 with a one feeding artery of 4.6 mm and nidus measuring 26.2 mm (maximum diameter).
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Twelve years earlier, she underwent first coil embolization of multiple PAVMs in the right S9 (Fig. 2) after massive hemoptysis.
Chest radiography. A) A day after first coil embolization. Two pulmonary arteriovenous malformations (PAVMs) in the right S9 were filled up with the total of sixteen detachable coils (DETACH DCS Coil or Cook Embolization Coil Tornado, Cook Japan, Tokyo, Japan).. B) A day before third coil embolization. There were coil compaction and deformation. One coil extended forward to proximal bronchi (*). The other coil extended forward to distal bronchi (white arrowhead). C) On the day she producing a thin wire. There remains the coil extended forward to central bronchus in the right B9 (*).
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The first procedure was technically successful and confirmed no coil migration on the next day (Fig. 3A). The chest X-ray, one day before the third coil embolization, demonstrated coil deformation (Fig. 3B). One the day she expectorated the thin wire, chest images confirmed one of the packed coils coming out in the form of a loop toward the proximal side (Fig. 3C).
Bronchoscopic findings. The thin looped wire was seen at right B9 (*). There were redness and swelling of the right B8 and B9 bronchial wall. No hemoptysis or purulent sputum were seen.The wire moved back and forth with the breath.
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Bronchoscopy confirmed another thin wire located in the right B9 bronchial lumen (Fig. 4).
Photograph of the resected right lower lobe. A) Coils in the cavity and bronchiectasis of the right B9b, which were covered with the debris. B) A cavity lesion (arrowhead) was perforated (arrow), and in communication with the bronchus. Histology demonstrated the cavity had fibrotic wall opening to the bronchi (rt. B8 and B9) with no communication to the interrupted embolized blood vessels (rt. A8a and V9b).
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Histology revealed that the cavity, containing debris with chronic inflammation and opening to the right B8 and B9, exhibited no communication with the vasculature, such as the right A8a or V9b, which ended beside the cavity (Fig. 5).