Bronchial artery to pulmonary artery fistula initially misdiagnosed as pulmonary embolism: A case report

• Published in: International journal of surgery case reports Vol. 115; p. 109246
• Main Authors: Khatri, Shivam, Epstein, Steven, Parikh, Rooshi, Chiong, Brian Bobby
• Format: Report
• Language: English
• Published: 01.02.2024
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109246

INTRODUCTIONBronchopulmonary arterial fistulas have been reported following lung transplant, and in association with COPD, trauma, radiation therapy, and infection. They may also arise congenitally. Embolization is the most frequent treatment.CASE PRESENTATIONWe present a case of a 58-year-old male with a prior history of pulmonary tuberculosis who initially presented with minimal hemoptysis for several months. Right upper lobe bronchial artery to pulmonary artery fistulas were discovered by angiography. These were excluded by particle and microcoil embolizations.CLINICAL DISCUSSIONRelatively unopacified blood from bronchial artery enters right pulmonary artery and causes ill-defined hypodensities mixing with opacified blood, especially compared to uniformly, brightly enhancing left pulmonary artery. As a result, interpreters will frequently incorrectly conclude that right pulmonary artery embolism exists rather than a bronchopulmonary arterial fistula.CONCLUSIONIn most cases, bronchopulmonary arterial fistulas are treated by bronchial artery embolization; however, direct puncture or stent grafting are alternate considerations depending on the patient's anatomy. In all instances, a multidisciplinary approach is a must.