Massive Hemoptysis due to Right Inferior Phrenic Artery-to-Right Pulmonary Artery Fistula in the Right Middle Lobe of the Lung

Abstract

Massive hemoptysis is a medical emergency and needs immediate treatment. It occurs in a wide variety of pulmonary diseases and typically originates from the bronchial arteries. We herein report a very rare case of a patient bleeding from a right phrenic artery-to-pulmonary artery fistula accompanied with focal bronchiectasis in the right middle lobe of the lung. In this case, multi-detector computed tomography was useful for clarifying the etiology and the abnormal anastomosis and facilitated effective angiographic embolization.

Transpleural systemic artery to pulmonary vessel fistulas: Imaging characteristics and management of an uncommon entity

“…In prior case reports of systemic to pulmonary artery fistulas involving the inferior phrenic artery, treatments varied between expectant management, embolization only, and embolization with surgical resection. [5][6][7][8][9] In our series, all patients were managed with single or staged embolization, although one had undergone surgical resection prior to embolotherapy. Embolic agents ranged between coils, liquid embolics (e.g., Onyx), and beads, depending of operator preference.…”

“…[4] However, transpleural systemic arterial to pulmonary vessel fistulas arising from abdominal arteries such as the inferior phrenic artery, as described in this case series, are rare. [5][6][7][8][9] These entities are prone to misdiagnosis if the imaging study used to characterize the lesion is not optimized for evaluation…”

Massive Hemoptysis Due to Anastomosis between the Left Phrenic Artery and Pulmonary Arteries/Veins

“…The literature describes several clinical cases of hemoptysis caused by fistula formation between the phrenic artery and pulmonary artery. Yakushiji et al published a similar clinical case with massive hemoptysis when an elderly woman had a right inferior phrenic artery-to-pulmonary artery fistula [10].…”

Systemic Artery-to-Pulmonary Artery Fistula Mimics Pulmonary Embolus

“…[2] At present, the preferred treatment modality for symptomatic patients is transarterial embolization, particularly for the immediate control of hemoptysis. [2,3]…”

“…Less than 10% of cases reported in literature involve the inferior phrenic artery. [3] The inferior phrenic artery should be suspected as an inflow vessel to SA-PAF when SA-PAF involves the lung base. In our case, the right inferior phrenic artery originated from the right renal artery [Figure 1d], which occurs in 10.5%–15.4% of reported cases.…”