CTICasesBronchial Artery to Pulmonary Artery Shunt Mimicking Pulmonary Embolism
Imaging findings
CT pulmonary angiography demonstrates a fuzzy, non-discrete filling defect in the interlobar pulmonary artery. The patient has extensive chronic airway disease, severe bronchiectasis, and associated hypertrophy of the bronchial arteries.
Key takeaways
Chronic and severe lung diseases (such as bronchiectasis or fibrosis) often lead to hypertrophy of the bronchial arteries, which can establish communications or shunts with the pulmonary arterial circulation. The resulting influx of unopacified blood from the systemic circulation into the opacified pulmonary artery can create a localized contrast dilution or flow phenomenon (classically referred to as "smoke") that mimics an acute pulmonary embolism.
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