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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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Newcomer J, Weber J, Galuppo R, Gabriel G, Diab C. Pulmonary artery-bronchus fistula treated with coil embolization. Radiol Case Rep 2022; 17:2652-2656. [PMID: 35663813 PMCID: PMC9160411 DOI: 10.1016/j.radcr.2022.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022] Open
Abstract
Bronchopulmonary arterial fistula consists of an abnormal connection between the bronchus and the vascular tree and is a rare but serious complication associated with a variety of lung interventions. We present a case of a 61-year-old female with a history of metastatic breast cancer treated with lumpectomy and radiation 20 years prior, who was found to have a fistula between the right pulmonary artery and the right mainstem bronchus. Our patient was treated endovascularly with coil embolization in the setting of massive hemoptysis flooding the trachea, which was successful in controlling the acute bleed, although care was withdrawn in the following days following a discussion with the family given the presence of advanced metastatic disease. This case illustrates the use of endovascular techniques to treat an actively bleeding bronchopulmonary arterial fistulae, including a review of the existing literature regarding the optimal endovascular management strategy. Although our patient did not achieve the best outcome, endovascular intervention with stent-placement or embolization can serve to temporarily halt blood flow through the fistula, stabilizing the patient and allowing for more radical therapy after improvement.
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Affiliation(s)
- Jack Newcomer
- University of Kentucky College of Medicine, Lexington, KY, 40506, USA
| | - Jonathon Weber
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, 40506, USA
| | - Roberto Galuppo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, 40506, USA
| | - Gaby Gabriel
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, 40506, USA
| | - Chadi Diab
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, 40506, USA
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Pulmonary Artery-Bronchus Fistula Treated with a Combination of Bare Metal Stent, Metallic Coil, and N-Butyl Cyanoacrylate. J Vasc Interv Radiol 2020; 32:152-155. [PMID: 33393469 DOI: 10.1016/j.jvir.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022] Open
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Cadour F, Gust L, Daviet F, Zieleskiewicz L, Dutau H, Scemama U. Combined Management of a Bronchial Artery Fistula After Lung Transplantation. Ann Thorac Surg 2019; 109:e99-e101. [PMID: 31276644 DOI: 10.1016/j.athoracsur.2019.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
A 46-year-old female patient exhibited massive endobronchial bleeding after dilation of a left bronchial anastomotic stenosis after lung transplantation, consistent with a bronchopulmonary artery fistula (BPAF). The BPAF was treated with a bronchial covered self-expandable metallic stent and percutaneous transcatheter pulmonary artery stent placement. BPAF is rare and leads to death in most cases because of massive hemoptysis. We describe a case of successful combined management of BPAF using both bronchial and pulmonary stent placement.
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Affiliation(s)
- Farah Cadour
- Department of Imaging, North University Hospital, Marseille, France
| | - Lucile Gust
- Department of Thoracic Surgery, North University Hospital, Marseille, France
| | - Florence Daviet
- Department of Critical Care (Acute Respiratory Failure and Severe Infections), North University Hospital, Marseille, France
| | | | - Herve Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Ugo Scemama
- Department of Imaging, North University Hospital, Marseille, France.
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Pulmonary lobar root clamping and stapling technique: return of the "en masse lobectomy". Gen Thorac Cardiovasc Surg 2012; 61:280-91. [PMID: 23054617 DOI: 10.1007/s11748-012-0159-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Most thoracic surgeons have experienced difficulty dissecting the pulmonary hilus because of scarring. In such potentially dangerous situations, we advocate a method of clamping and severing the pulmonary lobar root structure en masse. The aim of this study was to evaluate en masse lobectomy, particularly considering the constellation of pulmonary vessels and the bronchus. METHODS Twelve patients (median age 70 years) underwent en masse lobectomy. We retrospectively evaluated the surgical procedures and clinical outcomes. Care was taken to consider the remaining vessels and bronchus, which regulate the direction of device placement. RESULTS Seven patients had inflammatory lung disease, four had primary pulmonary carcinoma, and one had suffered blunt chest trauma. Ten operations were elective and two were emergent. Lobectomy included the right upper lobe in two cases, the right middle lobe in three, the right lower lobe in two, the right middle-lower lobe in two, and the left lower lobe in three. A stapler was used in ten patients, and sutures were applied in three (both were used in one case). Morbidities included a pyothorax and a persistent air leak; both made a recovery. Mortality included one emergency case of acute respiratory distress syndrome. No bronchopleural or bronchovascular fistulas occurred. CONCLUSIONS We believe that the en masse lobectomy is an alternative and necessary technique in critical or unexpected situations, possibly as a last resort. Trauma and severe inflammation may be good indications for en masse lobectomy.
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Yanagida R, Kass R, Czer L, Khoynezhad A. Endovascular repair of arterio-bronchial fistula of the outflow graft of HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg 2011; 142:710-1. [PMID: 21272896 DOI: 10.1016/j.jtcvs.2010.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/15/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Roh Yanagida
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, Calif, USA.
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Chawla M, Getzen T, Simoff MJ. Medical pneumonectomy: interventional bronchoscopic and endovascular management of massive hemoptysis due to pulmonary artery pseudoaneurysm, a consequence of endobronchial brachytherapy. Chest 2009; 135:1355-1358. [PMID: 19420204 DOI: 10.1378/chest.08-2091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Endobronchial brachytherapy serves as an excellent adjunct to standard external beam radiation therapy. The high dose of local radiation is still used to manage airway obstructions at some institutions, despite the well-known risks of airway fistulae to the esophagus or cardiovascular structures. A less reported complication is the development of a pulmonary artery pseudoaneurysm into the mainstem bronchi. The formation of an arterial pseudoaneurysm can lead to massive hemoptysis, which often is fatal. We present a case of massive hemoptysis due to this complication of brachytherapy managed entirely through bronchoscopic and endovascular techniques.
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Affiliation(s)
- Mohit Chawla
- Section of Interventional Pulmonology and Bronchoscopy, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI.
| | - Todd Getzen
- Division of Interventional Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI
| | - Michael J Simoff
- Section of Interventional Pulmonology and Bronchoscopy, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI
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Posttraumatic pulmonary arteriovenous fistula: is resection the procedure of choice? A case report and review of literature. ACTA ACUST UNITED AC 2009; 66:554-7. [PMID: 18349712 DOI: 10.1097/01.ta.0000221550.24390.6e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Samano MN, Saka JA, Caramori ML, Pêgo-Fernandes PM, Jatene FB. Fatal bronchovascular fistula after a single lung transplantation: a case report. Clinics (Sao Paulo) 2009; 64:1031-3. [PMID: 19841712 PMCID: PMC2763063 DOI: 10.1590/s1807-59322009001000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marcos Naoyuki Samano
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Juliana Akemi Saka
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Marlova Luzzi Caramori
- Pulmonology Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil., , Tel.: 55 113069.5248
| | - Paulo Manuel Pêgo-Fernandes
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Fabio Biscegli Jatene
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
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Jo KW, Hong Y, Han JH, Lee JK, Hong SB. A Case of Pulmonary Artery-bronchial Fistula with Massive Hemoptysis due to Pulmonary Tuberculosis. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.63.5.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - YoonKi Hong
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Hye Han
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Keun Lee
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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López-Benítez R, Richter GM, Luburic A, Böckler D, Kauffmann G, Hallscheidt PJ. False lumen embolization for type B dissection complicated by hemoptysis. Eur J Vasc Endovasc Surg 2005; 30:370-5. [PMID: 15975835 DOI: 10.1016/j.ejvs.2005.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 04/18/2005] [Indexed: 10/25/2022]
Abstract
In this report, we describe successful treatment of a patient with hemoptysis by false lumen embolization of a type B aortic dissection.
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Affiliation(s)
- R López-Benítez
- Department of Radiology, Heidelberg University Klinikum, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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