Incidental Bronchial Artery Aneurysm with Associated Bronchial Artery to Pulmonary Venous Fistula: Treatment By Embolization

Abstract

Background Bronchial artery aneurysm (BAA) is a rare vascular phenomenon with potentially life-threatening complications, especially since most cases are asymptomatic. Symptoms may vary depending on the aneurysm’s size and position Case Presentation Here we present the case of a 40 year old healthy gentleman who developed right sided chest pain following an exercise stress test for insurance purposes. CT of the chest showed an aneurysmal accessory artery arising from the thoracic aorta. Focused CT of the thoracic aorta showed a 21mm arterial aneurysm posterior to the left main bronchus with a long, tortuous efferent forming a fistula with the pulmonary venous circulation. The patient underwent prophylactic embolization and coiling of the aneurysm. Complete occlusion was confirmed on angiography. Discussion Size of bronchial artery aneurysm does not appear to be related to risk of rupture. Many are asymptomatic or present with rupture and haemorrhagic shock. BAAs should be treated immediately regardless of size and symptoms. Embolization is an acceptable treatment modality as it is minimally invasive however treatment is complex when concomitant fistula is present, especially in those with fistulation to the pulmonary venous circulation, due to risk of emboli entering the systemic circulation.