Recurrence of Pulmonary Arteriovenous Malformation with Non-tuberculous Mycobacteria Infection Caused by Perfusion from the Pulmonary Artery and Bronchial Artery after Coil Embolization

Abstract

Recurrence of an embolized pulmonary arteriovenous malformation (PAVM) is common after coil embolization. A 23-year-old woman who had undergone multiple instances of transcatheter coil embolization was admitted with hypoxia and hemoptysis. A PAVM in the left S6 was found to be recanalized by reperfusion through the pulmonary and bronchial arteries. The left S6 was partially resected; the specimen contained necrotic granulomas and non-tuberculous mycobacteria (NTM) around the PAVM. Clinicians should consider possible recurrence of PAVM after reperfusion of the pulmonary and bronchial arteries, as well as the risk of NTM infection during follow-up of patients who have undergone repeated coil embolization.

Hemoptysis after coil embolization for pulmonary arteriovenous malformation: Histopathological confirmation of bronchial epithelium extension

“…The embolic material appeared to act as a foreign material and prevented healing of the infection, resulting in chronic inflammation around the coils. In addition, it was reported that the presence of non-tuberculous mycobacteria was confirmed by examinations after lobectomy performed for hemoptysis after coil embolization of a PAVM [6] . In contrast, the present article is the first to describe histopathological results including chronic inflammation, and bronchial epithelium extension into the sac of the PAVM.…”

“…To clarify causes of hemoptysis, we reviewed articles extracted from PubMed using search terms “pulmonary arteriovenous malformations” and “embolization” and “hemoptysis.” Four cases of hemoptysis after embolization for PAVMs were identified [5] , [6] , [7] , [8] . In total, 6 cases including those 4 cases, and our 2 cases are summarized in Table 1 .…”

“…However, recanalization of embolized PAVM is known as a long-term issue [ 3 , 4 ]. Hemoptysis has been reported as another long-term problem of coil embolization [5] , [6] , [7] . However, the mechanisms underlying hemoptysis have not been clarified from histopathological examinations.…”