Long-term follow-up of unsuccessful coil embolisation in Osler-Weber-Rendu syndrome.

To cite: Tunsupon P, Yampikulsakul P, Punnanithinont N. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015214081 DESCRIPTION A 22-year-old woman was referred for management of intermittent haemoptysis. She had been diagnosed with hereditary haemorrhagic telangiectasia (HHT) when she was 5 years old and had undergone coil embolisation for treatment of pulmonary arteriovenous malformation (PAVM) at the ages of 6, 11 and 21 years. CT of the chest revealed multiple areas of PAVM and enhanced consolidation confined to the left lower lobe, and a large PAVM in the area that was previously coiled (figure 1). Pulmonary arteriogram was demonstrated (figures 2 and 3). There was no active site of contrast leaking, thus the patient was vigilantly monitored in the intensive care unit. However, she continued to experience intermittent haemoptysis. In the absence of randomised controlled trials for most of the available treatments for PAVM, the patient underwent a left partial lobectomy to prevent lifethreatening complications such as massive haemoptysis, brain abscess, paradoxical embolism and ischaemic stroke. The persistent pattern, defined as continuous perfusion of the PAVM, is demonstrated by