Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
J Cardiothorac Surg. 2022 Apr 27;17(1):87. doi: 10.1186/s13019-022-01841-7.
Percutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare.
A 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils.
Although percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient's symptoms and the risk fatal complications.
经皮血管介入治疗用于治疗咯血，包括支气管动脉、肺动脉和肺动静脉畸形栓塞。有孤立的报道称，在肺血管中形成假性动脉瘤的栓塞。在栓塞血管性肺病时，使用的线圈的成分迁移是罕见的。
一名 46 岁男性因咳嗽、咯血和咳出金属丝就诊于急诊科。他在入院前一年曾有一次咳出金属丝的经历，他将其归因于当时饮用的可口可乐罐中的金属丝，但并未向医生报告。他的既往病史包括 17 年前右侧胸部刺伤，因出血行右侧开胸探查术。发现肺实质损伤，并通过缝合缺损进行修复。术后 CT 扫描显示肺动脉假性动脉瘤形成。我们报告了一例患者在栓塞创伤性肺动脉假性动脉瘤 17 年后咳出线圈的病例。放射影像学检查显示线圈位于肺实质的肺门周围区域和气管支气管腔内。手术干预用于取出线圈。
虽然经皮导管血管介入治疗已成为安全有效的治疗方法，但长期并发症，如线圈迁移、再通和需要进一步栓塞等，应予以考虑，患者需要相应的咨询和随访。据我们所知，这是首例栓塞创伤性肺动脉假性动脉瘤后迁移线圈的病例。最终，对于栓塞后支气管内线圈迁移的处理，无论是手术还是支气管镜下处理，应根据患者的症状和致命并发症的风险进行个体化决策。
