CTICasesIatrogenic Vascular-Airway Fistula
Imaging findings
CT in a 51-year-old worker with a history of asbestos abatement shows extensive pleural plaques and an obstructing squamous cell cancer of the left main bronchus. A post-mortem chest radiograph demonstrates massive accumulation of gas (air) within the right ventricle and main pulmonary artery following a bronchoscopic tumor debulking procedure.
Key takeaways
During bronchoscopic debulking of central, obstructing lung cancers, the resection of tumor tissue that has invaded adjacent pulmonary vessels can create a direct communication between the airway and the venous/arterial circulation (vascular-airway fistula). This can lead to a catastrophic, fatal systemic or venous air embolism during positive pressure ventilation.
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