Management of an intercostal-pulmonary artery fistula in the setting of massive hemoptysis

Abstract

Introduction: Intercostal artery to pulmonary artery fistulas is exceptionally rare. The few cases reported in the literature are often found in asymptomatic patients, but this physiology can result in massive hemoptysis and subsequent respiratory failure secondary to aspiration. Case Report: A male in his 40s presented to our tertiary community hospital with massive hemoptysis and a known diagnosis of Mycobacterium szulgai; his past surgical history was pertinent for a coronary artery bypass with chest tube placement four years prior to his presentation and for remote pneumothoraces bilaterally. Angiography identified a fistulous connection between multiple intercostal artery trunks to a right upper lobe pulmonary artery that was coil embolized, successfully resolving his hemoptysis. Conclusion: This case report investigates a potential complication of those in an active inflammatory state, such as a mycobacterium infection, and the opportunity for minimally invasive treatment for those with massive hemoptysis.