The "Coil Associated Opacity" in endoscopic emphysema treatment. Friend or foe?

We describe two cases with very different outcomes.Cases: Two patients underwent staged bilateral coil treatment of their upper lobes, due to servere emphysema. All procedures were done under cover of antibiotics and prednisolone as recommended. The procedures were uneventful and both quickly had symptom and FEV1 improvement. Yet with different time intervals from the coil treatment, they both developed an episode with fever, cough, malaise and elevated WBC, chest x-ray opacity adjacent to the coils, and negative micobiology. Both with symptoms and findings equivalent of CAO. Unfortunatly CAO was not recognized in the one patient who deteriorated and succumbed due to circulatory collaps. Post mortem autopsy showed severe necrotizing inflammation in a DAD pattern including micro thrombi related to DIC as well as organizing pneumonia in the affected areas of the lung adjacent to the coils. The other patient received relevant steroid treatment and over time leading to an even greater lung volume reduction than seen shortly after coil treatment. FEV1 improved 34% compared to pre CAO.Summary: CAO can be a severe and life threatening complication especially if not acknowledged and treated sufficiently, while if treated the patient might actually experience additional lung volume reduction and further benefit from the coil treatment.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interventional Pulmonology Source Type: research