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Jo, Hong, Han, Lee, and Hong: A Case of Pulmonary Artery-bronchial Fistula with Massive Hemoptysis due to Pulmonary Tuberculosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(5): 430-434.

Published online: 30 November 2007

DOI: https://doi.org/10.4046/trd.2007.63.5.430

A Case of Pulmonary Artery-bronchial Fistula with Massive Hemoptysis due to Pulmonary Tuberculosis

Kyung-Wook Jo, M.D., YoonKi Hong, M.D., Jung-Hye Han, M.D., Jae-Keun Lee, M.D., Sang-Bum Hong, M.D.

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Sang-Bum Hong, M.D. Division of Pulmonary & Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3893, Fax: 82-2-3010-6968, sbhong@amc.seoul.kr

Received 10 September 2007       Accepted 15 October 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Massive and untreated hemoptysis is associated with a >50% mortality rate. Since bleeding has a bronchial arterial origin in most patients, bronchial artery embolization (BAE) has become an accepted treatment in massive hemoptysis. The possibility of bleeding from pulmonary artery should be considered in patients in whom the bleeding focus cannot be found by Bronchial angiogram. Indeed, the bleeding occurs from a pulmonary artery in approximately 10% of patients with massive hemoptysis. The most common causes of bleeding from the pulmonary artery are pulmonary artery rupture associated with a Swan-Ganz catheter, infectious diseases and vasculitis. We report a rare case of a fistula between the right upper lobar pulmonary artery and the right upper lobar bronchus in a 71-year-old woman who presented with massive hemoptysis.

Keywords: Pulmonary artery-bronchial fistula, Massive hemoptysis

Figures and Tables

Figure 1
The chest radiography showed consolidation combined with linear opacity on right upper lobe.
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Figure 2
Chest computed tomography scan showed air-space consolidation and multiple centrilobular nodules in right upper and middle lobe with irregular luminal narrowing of anterior segmental bronchi of right upper lobe.
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Figure 3
Reconstructed pulmonary embolism CT demonstrated a small sacuular aneurysm in proximal portion of the segmental branch, right upper lobar pulmonary artery and diffuse bronchial wall thickening in right main and upper lobar bronchus.
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Figure 4
Lung biopsy showed chronic granulomatous inflammation with caseous necrosis, nonspecific interstitial fibrosis, inflammatory infiltration with airspace organization.
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