Bronchial Artery to Pulmonary Artery Fistula Presenting with Massive
Hemoptysis in a Pediatric Patient
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 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.