CTICasesPulmonary Artery-Bronchial Fistula Secondary to Lung Abscess
Imaging findings
Bedside chest radiography shows opacities in the right lower lung. Follow-up chest CT demonstrates high-attenuation opacities in the right lower lobe, visually consistent with substantial acute hemorrhage. High-resolution axial and coronal CT images reveal a focal disruption and mural abnormality involving the medial wall of the right lower lobe pulmonary artery. Contrast-opacified blood can be traced passing directly from this pulmonary artery defect into the lumen of the adjacent bronchus, with blood pooling distally within abnormal, debris-filled airways.
Key takeaways
A pulmonary artery-bronchial fistula is a catastrophic and often fatal complication of a necrotizing lung infection. In this patient, autopsy confirmed a focal, airway-centric abscess containing abundant gram-positive rods and cocci that eroded directly into the adjacent branch of the pulmonary artery. Prompt recognition of high-attenuation airway blood on CT and rapid referral for emergency catheter angiography and embolization are critical, although patients often present in extremis with massive hemoptysis.
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