Bronchial artery-pulmonary artery fistula: case report of a very rare cause of pulmonary hypertension

Abstract

Bronchial-pulmonary arterial fistula is a very rare vascular malformation. We report a case of a 20-year-old male with Bronchial-pulmonary arterial fistula, a primary racemose hemangioma, presented with shortness of breath and echocardiographic findings of pulmonary hypertension and was investigated using 128-slice Multidetector Computed tomography (MDCT) scanner. Images of entire chest and upper abdomen were taken in pulmonary artery phase. CTPA showed bronchial artery to pulmonary artery fistula of the right upper lobe near hilar level. Bronchial arteries showed convolution and dilation, were connected with pulmonary arteries, suggesting the presence of primary racemose hemangioma. There was resultant retrograde filling of descending aorta confirming right to left shunt.
Clinical relevance: 128 slice MDCT with its high resolution and multiplanar imaging plays an instrumental role in diagnosing pulmonary vascular anomalies. Establishment of non-invasive treatment strategy for bronchial-pulmonary artery fistula is urgently required.