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Khatri S, Epstein S, Parikh R, Chiong BB. Bronchial artery to pulmonary artery fistula initially misdiagnosed as pulmonary embolism: A case report. Int J Surg Case Rep 2024; 115:109246. [PMID: 38219513 PMCID: PMC10826807 DOI: 10.1016/j.ijscr.2024.109246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Bronchopulmonary 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 PRESENTATION We 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 DISCUSSION Relatively 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. CONCLUSION In 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.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, New York, NY 10031, United States of America.
| | - Steven Epstein
- Department of Radiology, St. Barnabas Hospital, Bronx, NY 10457, United States of America
| | - Rooshi Parikh
- CUNY School of Medicine, New York, NY 10031, United States of America
| | - Brian Bobby Chiong
- Department of Radiology, St. Barnabas Hospital, Bronx, NY 10457, United States of America
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Brassil M, Li Y, Ko M, Faughnan ME, Prabhudesai V. Pre-operative embolization of a complex systemic to pulmonary vascular malformation. BJR Case Rep 2023; 9:20230056. [PMID: 37780979 PMCID: PMC10513012 DOI: 10.1259/bjrcr.20230056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
A 38-year-old male patient presenting with mild exertional dyspnea was noted to have a lingular opacity on chest radiograph. CT of the chest demonstrated an unusual complex inferior lingular vascular malformation with branches arising from the left internal thoracic artery and the left inferior diaphragmatic artery via the celiac artery. There was suspected communication with both pulmonary arterial and venous branches. Following thorough assessment and comprehensive clinical investigation, the patient elected to proceed to definitive surgical management due to potential risk of life-threatening hemoptysis. Interventional radiology performed pre-operative diagnostic angiography and embolization of the systemic feeding arteries. The patient proceeded to have an uncomplicated video-assisted thoracoscopic surgery segmentectomy and was discharged the next day. The patient was asymptomatic at follow-up with complete resolution of the malformation on CT at 6 months. We discuss an uncommon pathology which benefited from multidisciplinary management including successful pre-operative endovascular embolization.
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Affiliation(s)
- Michael Brassil
- Department of Medical Imaging, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Yangmei Li
- Department of Medical Imaging, St Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Michael Ko
- Department of Thoracic Surgery, St Joseph’s Health Center, Unity Health Toronto, Toronto, Canada
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Yan HT, Lu GD, Huang XZ, Zhang DZ, Ge KY, Zhang JX, Liu J, Liu S, Shi HB, Zu QQ. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis. BMC Pulm Med 2021; 21:419. [PMID: 34922497 PMCID: PMC8684203 DOI: 10.1186/s12890-021-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. Methods The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model’s variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. Results One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62–0.76), and lower prediction error (integrated Brier score, 0.143). Conclusion The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.
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Affiliation(s)
- Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Guang-Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Da-Zhong Zhang
- Department of Interventional Radiology, Jiangsu Taizhou People's Hospital, Taizhou, 225300, China
| | - Kun-Yuan Ge
- Department of Interventional Radiology, Yixing People's Hospital, Wuxi, 214200, China
| | - Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Marquis KM, Raptis CA, Rajput MZ, Steinbrecher KL, Henry TS, Rossi SE, Picus DD, Bhalla S. CT for Evaluation of Hemoptysis. Radiographics 2021; 41:742-761. [PMID: 33939537 DOI: 10.1148/rg.2021200150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - M Zak Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Travis S Henry
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Santiago E Rossi
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Daniel D Picus
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (K.M.M., C.A.R., M.Z.R., K.L.S., D.D.P., S.B.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (T.S.H.); and Department of Radiology, Centro Rossi, Buenos Aires, Argentina (S.E.R.)
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Gorsi U, Sharma M, Jugpal TS, Bhalla A, Sandhu MS. Bronchopulmonary arteriovenous malformation presenting as cryptogenic hemoptysis in a patient with bicuspid aortic valve. Lung India 2020; 37:257-259. [PMID: 32367849 PMCID: PMC7353941 DOI: 10.4103/lungindia.lungindia_243_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 44-year-old male patient with bicuspid aortic valve, presenting with hemoptysis. Catheter angiography revealed an abnormal communication between bronchial and pulmonary artery, which remained undetected on computed tomography angiography. Angioembolization was done using polyvinyl alcohol and gelfoam particles. This is the first case in literature describing bronchial arteriovenous malformation associated with bicuspid aortic valve.
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Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhurima Sharma
- Radiodiagnosis, Tanda Medical College, Tanda, Himachal Pradesh, India
| | - Tejeshwar Singh Jugpal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Louey S, Shanthikumar S, Harrison J, Vrazas J. Pediatric Racemose Hemangioma Treated with Angiographic Embolization. Am J Respir Crit Care Med 2020; 201:e70-e71. [PMID: 31930927 DOI: 10.1164/rccm.201907-1449im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Shivanthan Shanthikumar
- Respiratory and Sleep Medicine and.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia; and.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Joanne Harrison
- Respiratory and Sleep Medicine and.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia; and.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - John Vrazas
- Medical Imaging, The Royal Children's Hospital, Melbourne, Australia
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Jacheć W, Tomasik A, Kurzyna M, Pietura R, Torbicki A, Głowacki J, Nowalany-Kozielska E, Wojciechowska C. The multiple systemic artery to pulmonary artery fistulas resulting in severe irreversible pulmonary arterial hypertension in patient with previous history of pneumothorax. BMC Pulm Med 2019; 19:80. [PMID: 30991994 PMCID: PMC6469086 DOI: 10.1186/s12890-019-0832-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background Systemic artery to pulmonary artery fistulas (SA-PAFs), are extremely rare in people without congenital heart disease. In this group of patients pulmonary arterial hypertension was reported in the single case. Then, we describe a case of multiple SA-PAFs, which were the cause of severe nonreversible arterial pulmonary hypertension in a patient who had a right-sided pneumothorax 35 years earlier. Case presentation 52-year-old male Caucasian patient with echocardiographically confirmed pulmonary hypertension (PH) was admitted to cardiology department due to exertional dyspnea and signs of right ventricle failure. Routine screening for causes of secondary PH was negative. Right heart catheterization (RHC) confirmed a high degree arterial PH [mean pulmonary artery pressure (mPAP); 50,6 mmHg, pulmonary wedge pressure (PWP); 11,3 mmHg, pulmonary vascular resistance (PVR); 11,9 Wood’s units (WU)] irreversible in the test with inhaled nitric oxide. Oxygen saturation (SaO2) of blood samples obtained during the first RHC ranged from 69.3 to 73.2%. Idiopathic pulmonary arterial hypertension was diagnosed. Treatment with inhaled iloprost and sildenafil was initiated. Control RHC, performed 5 months later showed values of mPAP (59,7 mmHg) and PVR (13,4 WU) higher in comparison to the initial measurement, SaO2 of blood obtained during RHC from upper lobe artery of the right lung was elevated and amounted 89.7%. Then, pulmonary arteriography was performed. Lack of contrast in the right upper lobe artery with the evidence of retrograde blood flow visible as a negative contrast in the right pulmonary artery was found. Afterwards, right subclavian artery arteriography detected a huge vascular malformation communicating with right upper lobe artery. Following computed tomography angiogram (angio-CT) additionally revealed the enlargement of bronchial arteries originated fistulas to pulmonary artery of right upper lobe. In spite of intensive pharmacological treatment, including the therapy of pulmonary hypertension and percutaneous embolisation of the fistulas, the patient’s condition continued to deteriorate further. He died three months after embolisation due to severe heart failure complicated by pneumonia. Conclusion Non-congenital SA-PAFs are extremely rare, however, they should be excluded in patients with pulmonary arterial hypertension and history of inflammatory or infectious disease of the lung and pleura, pneumothorax, cancer or Takayashu’s disease and after chest trauma.
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Affiliation(s)
- Wojciech Jacheć
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland.
| | - Andrzej Tomasik
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 14/18 Borowa str, 05-400, Otwock, Poland
| | - Radosław Pietura
- Department of Radiography Medical, University of Lublin, Staszica 11 str., 20-081, 20-954, Lublin, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 14/18 Borowa str, 05-400, Otwock, Poland
| | - Jan Głowacki
- Department of Radiology and Nuclear Medicine, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 13-15 3-go Maja str, 41-800, Zabrze, Poland
| | - Ewa Nowalany-Kozielska
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
| | - Celina Wojciechowska
- 2nd Department of Cardiology, School of Medicine with Dentistry Division in Zabrze, Medical University of Silesia, 10 Curie-Sklodowska str, 41-808, Zabrze, Poland
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