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.