Korean J Radiol.  2012 Feb;13(1):102-106. 10.3348/kjr.2012.13.1.102.

Coronary to Bronchial Artery Fistula Causing Massive Hemoptysis in Patients with Longstanding Pulmonary Tuberculosis

• Yoon JY
• Jeon EY
• Lee IJ
• Koh SH

• KMID: 1058801
• DOI: http://doi.org/10.3348/kjr.2012.13.1.102

Abstract

We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

Keyword

Coronary artery; Bronchial artery; Pulmonary tuberculosis; Hemoptysis; Embolization

MeSH Terms

Aged
Arterio-Arterial Fistula/*complications/diagnosis
*Embolization, Therapeutic
Fatal Outcome
Female
Hemoptysis/*etiology/*therapy
Humans
Male
Middle Aged
Tomography, X-Ray Computed
Tuberculosis, Pulmonary/*complications

Figure

• 

  Fig. 1 Angiographies of both bronchial arteries and coronary-to-bronchial artery fistula in 70-year-old male, case 1. A, B. Both bronchial arteries are enlarged and embolized on initial embolization treatments. C. Coronary to bronchial artery fistula (arrow, proximal left circumflex arterial branch) to left upper lung with severe pulmonary artery shunt (not shown) is noted on left coronary angiography.

• 

  Fig. 2 Chest CT and angiography of right coronary artery in 57-year-old male, case 2. Chest CT images prior to first (A) and second (B) embolization treatments. Right lung lesions were improving but left lung lesions changed into cavitary lesions. Right coronary angiography (C, D) shows coronary to bronchial artery fistula with spastic change from proximal right coronary artery running along superior and inferior walls of left main bronchus (arrows).

• 

  Fig. 3 Chest CT and angiographies of both coronary arteries in 68-year-old female, case 3. A, B. Chest CT images prior to embolization treatment. Small tortuous coronary to bronchial artery fistula is suspected to be traversing right main pulmonary artery (thin arrows, A), and enlarged left and circumflex coronary arteries are seen (thin arrow, B). C, D. Early and late phases of right coronary angiography show enlarged coronary to bronchial artery fistula from proximal right coronary artery and massive pulmonary artery shunt (thick arrows). E. Left coronary angiography shows another enlarged coronary to bronchial artery fistula (thick arrow) that showed severe pulmonary artery shunt at left lower lung (not shown).

• 

  Fig. 4 Diagrammatic representation of work-up and treatment of coronary to bronchial artery fistula. CBF = coronary to bronchial artery fistula

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