Endovascular Treatment of Multiple Bronchial Artery Aneurysms With Prominent Fistula to Pulmonary Artery in a Patient With Interstitial Lung Disease: A Case Report and Literature Review

Abstract

Bronchial artery aneurysm (BAA) is a rare entity. Ruptured BAA can cause life-threatening hemorrhage. It is recommended that treatment should be initiated immediately after diagnosis. We present the case of a 56-year-old female with multiple BAAs and interstitial lung disease. Aortic computed tomography angiography demonstrated that the largest aneurysm at the right hilum was fed by right subclavian artery and right bronchial artery. A fistula between the pulmonary trunk and the aneurysm was also revealed. The patient underwent transcatheter embolization. Coils were placed in the feeding vessels instead of the aneurysms to avoid nontarget embolization of the pulmonary arteries through the fistula. The procedure achieved reduction in aneurysmal blood flow. The patient’s cough resolved at 6-month follow-up.

Bronchial artery to pulmonary artery fistula initially misdiagnosed as pulmonary embolism: A case report

“…Other interventions are also available. Resecting concomitant aneurysms or lobectomy have effected cure [ 13 ]. Stent graft placement was utilized to manage BPAF in two cases to date [ 14 , 15 ].…”

Endovascular Treatment of Incidentally Found Multiple Aneurysms Originating from a Bronchial Artery: A Case Report

“…Multiple BAAs are rarer than single or double lesions, and only 13 cases have been reported to date. The median age of patients with this disease is 57.5 years, and most patients are female ( 6 ). Our patient showed more than five BAAs, all of which originated from a single right bronchial artery.…”

Interlocking detachable coil embolization for giant tandem bronchial aneurysms

“…[ 4 ] Diseases related to BAA include bronchiectasis, chronic obstructive pulmonary disease, pulmonary vascular inflammation, chronic bronchial and lung infections, tuberculosis, cystic fibrosis, and hereditary hemorrhagic telangiectasia. [ 5 , 6 ] Some patients with BAA had no clear history of the disease. In this case, the aneurysm was caused by chronic inflammation of the bronchial dilatation with long-term irritation of the blood vessels, but the exact mechanism of formation needs to be further investigated.…”

“…The exact causes of BAA formation are unknown but can be grouped into 2 types: congenital and acquired [4] . Diseases related to BAA include bronchiectasis, chronic obstructive pulmonary disease, pulmonary vascular inflammation, chronic bronchial and lung infections, tuberculosis, cystic fibrosis, and hereditary hemorrhagic telangiectasia [5,6] . Some patients with BAA had no clear history of the disease.…”