Systemic to Pulmonary Arterial Fistula of the Chest Wall and Lung Following Lobectomy

Abstract

SUMMARY The comparatively few cases on record of shunting of blood from systemic arteries of the chest wall to the pulmonary circulation are classified according to their parietal or pulmonary origin and listed chronologically. The clinical features, plain radiological findings, angiographic investigation and possible aetiological mechanisms are reviewed, with particular reference to five of the group which followed a thoracic surgical procedure. The case is presented of a further fistula fed by multiple intercostal arteries and draining to pulmonary artery branches which complicated lobectomy. Particular reference is made to the plain film appearances of a local pulmonary lesion of vascular configuration and definite notching of adjacent ribs, a combination of findings not previously reported in a postoperative fistula. Stress is laid on the complementary roles of aortography, the definitive contrast study in this instance, and of pulmonary angiography in demonstrating the exact site of the shunt and its magnitude on the one hand, and its effect on the lesser circulation on the other. The development of two separate foci of abnormal vascular communication, each at some distance from the level of the original thoracotomv, is noted to be a further hitherto unrecorded finding for a fistula complicating surgical interference.

Systemic to Pulmonary Fistulas in Hodgkin’s Disease

“…Systemic to pulmonary fistula (STPF) is a very unusual pathology in arteriovenous fistulas and its association with hematological diseases like Hodgkin’s is extremely rare [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. We present a patient with Hodgkin’s disease and STPF with a favorable outcome after combined treatment with chemotherapy, radiotherapy and therapeutic embolization, resulting in a complete resolution of the abnormal vascular communications.…”

“…The congenital variety could be derived from embryonic connections between the systemic and pulmonary circulation of the fetus, while the acquired type is secondary to many processes, including: (1) pleural affections like pleuritis and pleural thickening; (2) previous lung surgery like lobectomies, as well as therapeutic pneumothorax and drainage tubes [2, 5, 9]; (3) Rendu-Osler-Weber disease; 50% of these patients have associated STPF; (4) fibroid changes due to parenchymal lung infections, like tuberculosis [6]; (5) vena cava syndrome; (6) postcongenital cardiopathic surgery, like ductus arteriovenous.…”

Multimodality Imaging Diagnostic Approach of Systemic‐to‐Pulmonary Vein Fistulae

“…It represents abnormal communications between intercostals arteries, lateral thoracic artery, mammary arteries, and pulmonary veins . SAPVF could be congenital or acquired . Most of the systemic‐to‐pulmonary vein fistulae are congenital.…”

“…Most of the systemic‐to‐pulmonary vein fistulae are congenital. Very rare cases of acquired SAPVF after pulmonary lobectomy, after tuberculosis, after congenital heart disease surgeries and after superior vein cava syndrome were reported . The diagnosis of SAPVF can be challenging due to variable clinical presentation .…”

“…2 SAPVF could be congenital or acquired. [2][3][4][5] Most of the systemicto-pulmonary vein fistulae are congenital. Very rare cases of acquired SAPVF after pulmonary lobectomy, after tuberculosis, after congenital heart disease surgeries and after superior vein cava syndrome were reported.…”