Endobronchial Erosion of a Pulmonary AVM Coil Presenting as a Cavitary Lung Lesion
Abstract
Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections that predispose patients to hypoxemia and paradoxical embolic events. Endovascular coil embolization is the preferred treatment for these lesions and is associated with high technical success and low immediate complication rates. While delayed complications, such as recanalization or migration are rare, erosion of embolization coils into the tracheobronchial tree is uncommon and poorly characterized. We report a 42-year-old woman with history of PAVM treated with coil embolization in 2018 who presented seven years later with recurrent hemoptysis and persistent cavitary lesion in the left lower lobe. Since embolization, she had experienced intermittent hemoptysis and recurrent episodes of presumed pneumonia. Extensive infectious evaluation, including testing for tuberculosis and fungal disease, was negative. Flexible bronchoscopy revealed a metallic foreign body protruding into the basilar segment of the left lower lobe. During bronchoscopy, the object was recognized as the endovascular coil from the prior AVM embolization. Attempted extraction resulted in the partial unraveling of the coil, requiring intubation to secure the wire. The patient was transferred to a tertiary care center for definitive treatment with thoracic surgery available as backup. Rigid bronchoscopy demonstrated erosion of the coil into the airway without active bleeding. Gentle traction allowed complete removal of the intrabronchial portion of the coil without hemorrhage or airway injury, and lobectomy was avoided. This case illustrates an unusual complication of PAVM embolization presenting as cavitary lung disease and hemoptysis years after intervention. The prolonged latency illustrates the possible contribution of chronic inflammation and infection to progressive device erosion. Recognition of prior intravascular devices is critical, as bronchoscopic manipulation carries a risk of catastrophic hemorrhage. Endobronchial erosion of PAVM coils, though rare, should be considered in patients with unexplained cavitary lung lesions and history of embolization. Management requires multidisciplinary coordination to minimize procedural risk.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
12
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Venkata Vedantam
Endobronchial Erosion of a Pulmonary AVM Coil Presenting as a Cavitary Lung Lesion
Culp Ballroom 316
Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections that predispose patients to hypoxemia and paradoxical embolic events. Endovascular coil embolization is the preferred treatment for these lesions and is associated with high technical success and low immediate complication rates. While delayed complications, such as recanalization or migration are rare, erosion of embolization coils into the tracheobronchial tree is uncommon and poorly characterized. We report a 42-year-old woman with history of PAVM treated with coil embolization in 2018 who presented seven years later with recurrent hemoptysis and persistent cavitary lesion in the left lower lobe. Since embolization, she had experienced intermittent hemoptysis and recurrent episodes of presumed pneumonia. Extensive infectious evaluation, including testing for tuberculosis and fungal disease, was negative. Flexible bronchoscopy revealed a metallic foreign body protruding into the basilar segment of the left lower lobe. During bronchoscopy, the object was recognized as the endovascular coil from the prior AVM embolization. Attempted extraction resulted in the partial unraveling of the coil, requiring intubation to secure the wire. The patient was transferred to a tertiary care center for definitive treatment with thoracic surgery available as backup. Rigid bronchoscopy demonstrated erosion of the coil into the airway without active bleeding. Gentle traction allowed complete removal of the intrabronchial portion of the coil without hemorrhage or airway injury, and lobectomy was avoided. This case illustrates an unusual complication of PAVM embolization presenting as cavitary lung disease and hemoptysis years after intervention. The prolonged latency illustrates the possible contribution of chronic inflammation and infection to progressive device erosion. Recognition of prior intravascular devices is critical, as bronchoscopic manipulation carries a risk of catastrophic hemorrhage. Endobronchial erosion of PAVM coils, though rare, should be considered in patients with unexplained cavitary lung lesions and history of embolization. Management requires multidisciplinary coordination to minimize procedural risk.
