Coronary artery-bronchial artery fistulas: report of two Dutch cases with a review of the literature

Abstract

BackgroundCoronary bronchial artery fistulas (CBFs) are rare anomalies, which may be isolated or associated with other disorders.Materials and methodsTwo adult patients with CBFs are described and a PubMed search was performed using the keywords “coronary bronchial artery fistulas” in the period from 2008 to 2013.ResultsTwenty-seven reviewed subjects resulting in a total of 31 fistulas were collected. Asymptomatic presentation was reported in 5 subjects (19 %), chest pain (n = 17) was frequently present followed by haemoptysis (n = 7) and dyspnoea (n = 5). Concomitant disorders were bronchiectasis (44 %), diabetes (33 %) and hypertension (28 %). Multimodality and single-modality diagnostic strategies were applied in 56 % and 44 %, respectively. The origin of the CBFs was the left circumflex artery in 61 %, the right coronary artery in 36 % and the left anterior descending artery in 3 %. Management was conservative (22 %), surgical ligation (11 %), percutaneous transcatheter embolisation (30 %), awaiting lung transplantation (7 %) or not reported (30 %).ConclusionsCBFs may remain clinically silent, or present with chest pain or haemoptysis. CBFs are commonly associated with bronchiectasis and usually require a multimodality approach to be diagnosed. Several treatment strategies are available. This report presents two adult cases with CBFs and a review of the literature.

Surgical Management of a Coronary-Bronchial Artery Fistula Combined with Myocardial Ischemia Revealed by 13N-Ammonia Positron Emission Tomography

“…They proposed that 2 factors regulate the reopening and growth of arterial communications: disequilibrium of the pressure gradient between the 2 arteries and obstruction of the coronary arteries. Additionally, several case series have implied the possibility of a relationship between coronary-bronchial artery fistula and known bronchiectasis [2,5]. Similar to the patients who have previously been described, our patient also suffered from bronchiectasis.…”

“…According to a review article from the Netherlands, only 31 such fistulas were reported in the period from 2008 to 2013 [2]. Due to the advanced radiologic techniques that are currently used, such as MDCT, diagnosing coronary-bronchial artery fistula has become less complicated [3,4].…”

“…Percutaneous transcatheter embolization may be the treatment of choice in most patients without concomitant cardiac disease, whereas surgical ligation is also effective in selected patients [2]. Patients with coronary-bronchial artery fistula and concomitant cardiac disease need more consideration for selecting the best treatment modality.…”

Case Report: A Rare Case of Coronary-Bronchial Fistula Associated with a Large Lung Bullae and Bronchiectasis Presenting as Dyspnea

“…Said et al suggested the possibility of the reopening of a preexisting non functional congenital communications between the bronchial arteries. they proposed that two factors regulate the reopening and growth of the arterial communication: Desequilibrium of the pressure gradient between the two arteries and obstruction of the coronary artery [8]. Many case series have implied the possibility of a relationship between CBF and bronchiectasis in one or both lungs [9].…”

Coronary to Bronchial Artery Fistula

“…Systemic bronchial artery fistula may be silent, or present with chest pain or hemoptysis. 1 It is usually related with bronchiectasis. Various imaging modalities should be considered to identify multiple fistulas, or the course and termination site of the fistula.…”