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 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.

Cryptogenic massive hemoptysis caused by bronchial artery–pulmonary artery fistula in a 12‐year‐old boy: A case report and literature review

“…Few cases of BPF have been reported in the medical literature and only five reports on BPF in children could be identified in the PubMed database (Table 1). 3,9,13,17,18 We will summarize findings from the five previous reports and our case report. The onset age of these children was 9–15 years old, mostly male, and they were all hospitalized with acute hemoptysis or hemoptysis after cough (over 100 ml bright red blood), with or without chest tightness and pain.…”