Rasmussen unraveled: endovascular coil migration after pseudoaneurysm embolization
Year: 2026
Type: article
Study design: Case Report
Abstract: A 65-year-old man with newly diagnosed, smear-positive pulmonary tuberculosis presented with several tablespoons of hemoptysis and underwent computed tomography of the chest, which demonstrated a thick-walled cavity in the left lower lobe and an adjacent segmental pulmonary artery pseudoaneurysm (Figure 1A). Angiography and embolization of the pseudoaneurysm were performed using 2 hydrogel-coated platinum coils (AZUR CX Detachable HydroCoil, 0.018’, 36 cm; Terumo Figure 1B, C), resulting in immediate resolution of extravasation on angiography. Routine follow-up imaging 8 weeks after tuberculosis treatment initiation revealed a partially unraveled coil extending from the tuberculous cavity into the bronchus and trachea, past the larynx and retroflexing into the mid-thoracic esophagus (Figure 1D, E). The patient denied cough, dyspnea, or hemoptysis. Rigid bronchoscopy was performed, which confirmed an unraveled coil transversing the vocal cords and extending into the esophagus. The unraveled limb of the coil was ligated at the level of the left lower lobe segmental bronchus and removed (Figure 1F-H). The patient subsequently completed 9 months of anti-TB therapy with no further episodes of hemoptysis at 3-year follow-up. (A) Computed tomography (CT) on hemoptysis presentation, demonstrating left Middle lobe cavity and pseudoaneurysm. (B) Pulmonary arterial angiogram, demonstrating 8 mm Rasmussen’s aneurysm adjacent to the tuberculous cavity, (C) which was successfully coiled (D) Scout film and (E) 3D reconstruction of CT chest at 4-week follow-up, demonstrating a partially unraveled coil traveling into the left mainstem bronchus, trachea and retroflexing into the esophagus. (E) Rigid bronchoscopic view of the unraveled coil traveling along the distal left lower lobe segmental airway (G), which was successfully clipped with a rigid biopsy forceps. (H) Unraveled portion of the coil following removal via rigid bronchoscopy. Pulmonary artery pseudoaneurysm, eponymously referred to as Rasmussen aneurysm, occurs in 4%-7% of pulmonary tuberculosis patients presenting with hemoptysis.1,2 Though angiography and embolization have been shown to drastically reduce mortality rates, data on type and timing of intervention remain limited to small retrospective case series.3–8 Coil migration is a known complication following endovascular coil embolization of pulmonary arteriovenous malformations (AVM). However, endobronchial coil migration in the setting of a Rasmussen pseudoaneurysm has seldom been reported, reflecting anatomical differences between vessel wall characteristics of the pulmonary artery and the relative infrequency of embolization in pseudoaneurysm compared to AVMs. To our knowledge, this is the first documented case of coil migration following Rasmussen’s aneurysm embolization, uniquely treated by successfully removing only the unraveled coil while safely leaving the remainder in a cavitary space.9,10 Whether and how coil type or material affects risk of coil migration remains uncertain. Justin C. Zhang was responsible for visualization, design, and writing the manuscript. Melanie F. Weingart was responsible for conceptualization and editing the manuscript. Adali Martinez, Mark Wilson, Janice Louie, and Richard J. Wang were responsible for editing the manuscript. Diana H. Yu was responsible for conceptualization and editing of the manuscript. Supplementary material is available at American Journal of Respiratory and Critical Care Medicine online. Please see the ICMJE disclosure forms, which have been provided as supplementary material. No artificial intelligence tools were used in writing this manuscript.
Authors: Justin C Zhang, Melanie F Weingart, Adali Martinez, Mark Wilson, Janice Louie, Richard J Wang, Diana H Yu
Language: English
Subfield: Genetics (clinical)
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7125611896