CTICasesBronchial-to-Pulmonary Artery Fistula
Imaging findings
CT angiography shows a vascular aneurysm in the right lower lobe pulmonary artery with a focal 'smoke' artifact of unopacified blood inflow. Repeat imaging using a high-contrast saline flush sequence demonstrates a patent fistula connecting the hypertrophied bronchial artery to the pulmonary artery, likely secondary to childhood pneumonia.
Key takeaways
Spontaneous bronchial-to-pulmonary artery fistulas are rare vascular anomalies that can simulate pulmonary emboli due to unopacified systemic blood inflow ('smoke' sign). Saline flush sequences can help differentiate these flow-related artifacts from true thrombi by demonstrating positive contrast inflow.
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