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Bronchial Artery to Pulmonary Artery Fistula Presenting with Massive Hemoptysis in a Pediatric Patient
  • Aoife Corcoran,
  • Silvia Cardenas
Aoife Corcoran
Cleveland Clinic
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Silvia Cardenas
Cleveland Clinic Children's Hospital
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Abstract

Hemoptysis is a serious and potentially life-threatening event. Mortality is estimated at 13% for this chief complaint with age, volume of hemoptysis and receipt of blood products as risk factors for mortality. Hemoptysis is mostly seen in those with underlying congenital cardiac conditions or Cystic Fibrosis. We describe a unique case of a previously healthy 10 year old male who presented to the ED by EMS with a moderate volume episode of hemoptysis. He was admitted to the PICU where a sudden episode of massive hemoptysis precipitated by forced respiratory effort occurred during his examination. He decompensated and was emergently brought to the OR for airway evaluation by ENT and pulmonology. A large clot was found in the RML segment with brisk bleeding following removal of the clot. A 5 Fr bronchial blocker was placed to achieve hemostasis. Bronchial artery angiogram by IR demonstrated extravasation of contrast from right bronchial artery to segmental right lower lobe pulmonary artery shunt. He underwent embolization of the right bronchial artery. He was extubated the following day after no recurrent bleeding was confirmed with bronchoscopy. BA-PA fistulas are rare vascular anomalies in which an anastomosis is formed between systemic and pulmonary arteries. They are most commonly acquired, often described as secondary to chronic inflammatory lung diseases. BA-PA fistulas can also be congenital and have been seldom described in the literature. Our case highlights the importance of this rare diagnosis, which must remain on a pediatric pulmonologist’s differential due to the significant associated mortality.

Peer review status:ACCEPTED

10 Jul 2021Submitted to Pediatric Pulmonology
12 Jul 2021Submission Checks Completed
12 Jul 2021Assigned to Editor
13 Jul 2021Reviewer(s) Assigned
21 Jul 2021Review(s) Completed, Editorial Evaluation Pending
31 Jul 2021Editorial Decision: Revise Minor
01 Aug 20211st Revision Received
02 Aug 2021Submission Checks Completed
02 Aug 2021Assigned to Editor
02 Aug 2021Reviewer(s) Assigned
03 Aug 2021Review(s) Completed, Editorial Evaluation Pending
05 Aug 2021Editorial Decision: Accept