A case of pulmonary arteriovenous fistula failed in transcatheter embolization and followed by emergency operation

: We reported a 55-year-old male case with pulmonary arteriovenous fistula. The lesion existed in right S9b and was about 6 cm in diameter. The afferent artery and the efferent vein, both were more than 10 mm in diameter, were shown on the chest CT and DSA film. At first transcatheter embolization with steel coils and Histoacryl was tried. Though we succeeded in embolization of the afferent artery, embolization of the fistula was failed because of reflux from the drainage vein. And a coil, a fragment of Histoacryl dropped and floated in the fistula. With concerning about the risk of embolization of the other organ with these materials, we performed the enucleation of the fistula at the next day. Although transcatheter embolization is useful in treating pulmonary arteriovenous fistula, in the case of wide communication with large drainage vein such as our case, it seems to be risky.