CTICasesSystemic-to-Pulmonary Artery Fistula
Imaging findings
A patient with chronic lung scarring showed a linear, low-attenuation defect that was initially misidentified as chronic pulmonary embolism. Multiphase CT revealed that a hypertrophied intercostal artery was anastomosing with the pulmonary artery, causing systemic inflow into the pulmonary circulation.
Key takeaways
These fistulas can mimic chronic PE on standard imaging. Having multiple phases of contrast (specifically a systemic arterial phase) is critical for identifying the source of anomalous arterial flow.
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