CTICasesSystemic-to-Pulmonary Arterial Fistulae from Thoracic Trauma
Imaging findings
CTA in a patient with prior blunt thoracic trauma and rib fractures demonstrates multiple enlarged intercostal arteries and a lateral costal artery feeding directly into pulmonary arterial branches in the right upper lobe via systemic-to-pulmonary arteriovenous fistulae. On pulmonary arteriography, retrograde flow from the intercostal arteries into the pulmonary artery branches is demonstrated, with absent antegrade pulmonary arterial flow in the fistulous segments. V/Q scan shows matched perfusion defects.
Key takeaways
Systemic-to-pulmonary arterial fistulae may develop after thoracic trauma (blunt injury, tube thoracostomy) or chronic pleural inflammation due to inflamed pleura recruiting intercostal arterial collaterals that form fistulous connections with the pulmonary artery branches. These can cause recurrent hemoptysis and produce filling defects on CT pulmonary angiography that closely mimic pulmonary emboli. Pulmonary arteriography demonstrating retrograde flow and the absence of true intraluminal clot confirm the diagnosis.
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