Tuberc Respir Dis.  2007 Nov;63(5):430-434. 10.4046/trd.2007.63.5.430.

A Case of Pulmonary Artery-bronchial Fistula with Massive Hemoptysis due to Pulmonary Tuberculosis

• Jo KW
• Hong YK
• Han JH
• Lee JK
• Hong SB

• KMID: 2050476
• DOI: http://doi.org/10.4046/trd.2007.63.5.430

Abstract

Massive and untreated hemoptysis is associated with a >50% mortality rate. Since bleeding has a bronchial arterial origin in most patients, bronchial artery embolization (BAE) has become an accepted treatment in massive hemoptysis. The possibility of bleeding from pulmonary artery should be considered in patients in whom the bleeding focus cannot be found by Bronchial angiogram. Indeed, the bleeding occurs from a pulmonary artery in approximately 10% of patients with massive hemoptysis. The most common causes of bleeding from the pulmonary artery are pulmonary artery rupture associated with a Swan-Ganz catheter, infectious diseases and vasculitis. We report a rare case of a fistula between the right upper lobar pulmonary artery and the right upper lobar bronchus in a 71-year-old woman who presented with massive hemoptysis.

Keyword

Pulmonary artery-bronchial fistula; Massive hemoptysis

MeSH Terms

Aged
Bronchi
Bronchial Arteries
Catheters
Communicable Diseases
Female
Fistula*
Hemoptysis*
Hemorrhage
Humans
Mortality
Pulmonary Artery
Rupture
Tuberculosis, Pulmonary*
Vasculitis

Figure

• 

  Figure 1 The chest radiography showed consolidation combined with linear opacity on right upper lobe.

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  Figure 2 Chest computed tomography scan showed air-space consolidation and multiple centrilobular nodules in right upper and middle lobe with irregular luminal narrowing of anterior segmental bronchi of right upper lobe.

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  Figure 3 Reconstructed pulmonary embolism CT demonstrated a small sacuular aneurysm in proximal portion of the segmental branch, right upper lobar pulmonary artery and diffuse bronchial wall thickening in right main and upper lobar bronchus.

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  Figure 4 Lung biopsy showed chronic granulomatous inflammation with caseous necrosis, nonspecific interstitial fibrosis, inflammatory infiltration with airspace organization.

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