Successful transcatheter arterial embolization of asymptomatic aneurysm associated with left inferior phrenic artery-to-left pulmonary artery fistula: A case report

Abstract

Cases of inferior phrenic artery-to-pulmonary artery fistulas and those complicated by massive hemoptysis have been rarely reported. A 38-year-old man presented to our hospital with a chief complaint of coughing. Computed tomography (CT) revealed a nodule in the left lower lobe, and contrast-enhanced CT showed inflow of contrast medium into the nodule. CT angiography detected an aneurysm associated with a left inferior phrenic artery-to-left pulmonary artery fistula. Transcatheter arterial embolization (TAE) was performed to prevent hemoptysis. Hemoptysis did not occur during the 2-year follow-up. We report a rare case of asymptomatic aneurysm associated with a left inferior phrenic artery-to-left pulmonary artery fistula, which was successfully treated using TAE to prevent hemoptysis.

Right inferior phrenic artery to right pulmonary artery fistula causing hemothorax: A case report

“…At the time, surgical resection of the involved lung lobe was done, with ligation of the connecting systemic arteries to prevent hemorrhage [3] . More recent cases described by Wynne et al, Shimmyo et al, Juergens et al, and Kawakado et al all describe various SA-PAF presentations and their repair using endovascular embolization [1] , [2] , [3] , [4] , [5] . Wynne et al describes a right inferior phrenic artery to right pulmonary artery fistula found incidentally while evaluating for cause of ischemic thalamic stroke, with embolization done to reduce the risk of cor pulmonale [2] .…”

“…Juergens et all describe a right inferior phrenic artery to right pulmonary artery fistula in a woman with chronic dyspnea; 2 separate embolizations were performed due to the systemic side having connections with the right lateral thoracic, hepatic, and inferior epigastric arteries [5] . Kawakado et al describe finding a left inferior prhenic artery to left pulmonary artery fistula in a man with acute cough, with embolization done to prevent future development of hemoptysis [1] .…”

“…Systemic artery to pulmonary artery fistulae (SA-PAF) are a rare anomaly usually seen on CT angiogram of the chest when looking for causes of conditions such as hemoptysis, cough, or ischemic stroke [1 , 2] . SA-PAF were first described in 1947 [3] and were initially treated with surgical resection and vascular ligation.…”

“…SA-PAF were first described in 1947 [3] and were initially treated with surgical resection and vascular ligation. More recently, SA-PAF can be repaired by embolizing the fistula intravascularly [1 , 2] . We report a case of inferior phrenic artery to right pulmonary artery fistula that resulted in a large hemothorax with subsequent embolization by interventional radiology.…”