Figure 1: Chest X- ray PA view shows an irregular tubular radiodense
lesion on the right hilar region (arrow).
CT angiogram of the chest demonstrated a cluster of dilated and tortuous
vessels (Figures 2 and 3) in the right paraspinal region, 5th and 6th
intercostal areas, and the superior segment of the right lower lobe with
3 feeding vessels arising from the aorta ( Figure 4) and draining into
the superior segmental branch of the right descending pulmonary artery
(Figures 5 and 6). No abnormality of the lung was noted. A diagnosis of
congenital bronchial artery-pulmonary artery fistula was made.
Differential diagnosis for the case was pulmonary arteriovenous
malformation, vascular malformations, coarctation of the aorta with
collaterals however, CT angiogram clearly demonstrated normal aorta and
the presence of feeding vessels from the aorta draining into the
superior segmental branch of the right descending pulmonary artery which
ruled out these differentials. Patient was explained about the diagnosis
and treatment options. He refused treatment and opted to be on regular
follow-up.