LAUSR

A 51-year-old male patient with a history of cirrhosis complicated by previous bleeding from gastric varices presented with a 2-week history of chest pain and a dry cough. On admission, vital signs were normal except for a mildly elevated respiratory rate of 20 (SpO2: 96%). Chest examination was clear. The electrocardiogram was unremarkable, and the x-ray demonstrated a coil in the left pulmonary hilum. D-Dimer was increased (688 ng/mL). An urgent chest computed tomography confirmed the finding of the chest x-ray (Fig. 1). This case illustrates a gastric variceal coil pulmonary embolization, consistent with the patient’s history of endoscopic varix treatment 8 and 11 months prior in the context of secondary prophylaxis. His initial endoscopic ultrasound (EUS) demonstrated a gastric fundal varix measuring 30–40 mm in the largest diameter. Stigmata of recent bleeding was present. At our institute, gastric variceal coiling is performed under EUS guidance without fluoroscopy. A 19-gauge needle is punctured into the gastric varix, and blood is aspirated to confirm the position (Fig. 2). The number of coils used is determined by the diameter of Figure 1 Chest computed tomography confirming the chest x-ray findings of a migrated coil into a left lower lobe artery (dotted white arrow), without associated infarctions or consolidations. The gastric variceal coils can be seen at the fundus of the stomach (solid white arrow). Figure 2 An endoscopic ultrasound image of the 10-mm 0.018-inch embolization coils (MicroNester®; Cook Medical) about to be deployed via a 19-gauge needle into the gastric varix (solid white arrow).