Sibel KARA, Nazan ŞEN, Uğur ÖZKAN, Şule AKÇAY

Genç Erişkin Bir Olguda Konjenital Bronşiyal Arter - Pulmoner Arter Fistülü

Bronşial arter ve pulmoner arter veya pulmoner ven arasındaki bağlantı gibi primer vasküler malformasyonlar olukça nadirdir. İlk kez olan masif hemoptizi ile başvuran 18 yaşındaki bir erkek hastada selektif bronşial anjiografide nadir bir vasküler anomali olan bronşial arter-pulmoner arter fistülü saptandı. Öyküde hiç bir kazanılmış neden bulunmadığı için konjenital olarak düşünüldü. Olguya bronşial arter embolizasyonu uygulandı ve hemoptizisi endovasküler tedaviden sonra tamamen düzeldi. Masif hemoptizili hastalarda böyle vasküler anomalilerden şüphelenilmelidir. Bronşial arter embolizasyonu bu hastalarda güvenli ve etkili cerrahi olmayan bir tedavi yöntemidir.

Congenital Bronchial Artery - Pulmonary Artery Fistula in a Young Adult

Primary vascular malformations such as connection between bronchial artery and pulmonary artery or pulmonary vein are quite rare. A 18-year-old male patient with the first episode of massive hemoptysis was found to have bronchial artery-pulmonary artery fistula, a rare vascular anomaly, on selective bronchial angiography. Since medical history revealed no acquired cause, it is considered congenital. He underwent bronchial artery embolization and hemoptysis was completely resolved after endovascular treatment. The presence of such vascular anomalies should be suspected in patients with massive hemoptysis. Bronchial artery embolization is a safe and effective nonsurgical treatment option for such patients.

Keywords:

Hemoptysis, vascular malformation, bronchial artery-pulmonary artery fistula, bronchial artery embolization,

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Leslie KO, Yousem SA, Colby TV. Lung. In: Mills SE ed. Histology for pathologists. 3rd ed. Philadelphia: Lippincott Williams and Wilkins., 2007:473-507.
Gossage JR, Kanj G. Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med. 1998;158:643-61.
Lacomp P, Lagrance C, Beauched A, El Hajjam M, Chinet T, Pelage JP. Diffuse pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: long-term results of embolization according to the extent of lung involvement. Chest. 2009;135:1031-37.
Yon JR, Ravenel JG, Congenital bronchial artery- pulmoner artery fistula in an adult. J Comput Assist Tomogr. 2010;34:418-20.
Sluiter-Eringa H, Orie NG, Sluiter HJ. Pulmonary arteriovenous fistula. Diagnosis and prognosis in non-complainant patients. Am Rev Respir Dis. 1969;100:177-88.
Dines DE, Arms RA, Bernatz PE, Gomes MR. Pulmonary arteriovenous fistulas. Mayo Clin Proc. 1974;49:460-5.
Chino M, Kawaguchi T, Sakai T, Okuno T. Intercostal-to-pulmonary arterial anastomosis, complicated by high-output heart failure: case report. Angiology. 1991;42:256-60.
Do KH, Goo JM, Im JG, Kim KW, Chung JW, Park JH. Systemic arterial supply to the lungs in adults: spiral CT findings. Radiographics. 2001;21:387-402.
Geyik S, Yavuz K, Keller FS. Unusual systemic artery to pulmonary artery malformation without evidence of systemic disease, trauma or surgery. Cardiovasc Intervent Radiol. 2006;29:897-901.
Tadavarthy SM, Klugman J, Castaneda-Zuniga WR, Nath PH, Amplatz K. Systemic- to–pulmonary collaterals in pathological states: a review. Radioglogy. 1982;144:55-9.
Saluja S, Henderson KJ, White RI Jr. Embolotherapy in the bronchial and pulmonary circulations. Radiol Clin North Am. 2000;38:425-48.
Uchiyama D, Fujimoto K, Uchida M, Koganemaru M, Urae T, Hayabuchi N. Bronchial arteriovenous malformation: MDCT angiography findings. AJR. 2007;188:409-11.
Thurer RJ, Comminication between the pulmonary and systemic circulation. Ann Thoracic Surg. 1976;21:114-22.
Ito T, Sakamoto T, Norio H, Kaji T, Okada Y. An arteriovenous fistula between the internal mammary artery and the pulmonary vein following blunt chest trauma. Cardiovasc Intervent Radiol. 2005;28:120- 23.
Heper G, Barcin C, İyisoy A, Tore HF. Treatment of an iatrogenic left internal mammary artery to pulmonary artery fistula with a bovine pericardium covered stent. Cardiovasc Intervent Radiol. 2006;29:879-82.
Poh SC, Wang YT, Tan LK. Systemic to pulmonary artery fistulas in Hodgkin’s disease. Am Rev Respir Dis. 1986;134:1324-26.
Taichman DB, Fishman AP. Approach to the patient with respiratory symptoms. In: Fishman AP ed. Fishman’s pulmonary diseases and disorders. 4th ed. China: Mc Graw-Hill Company. 2008:387-427.
Cremaschi P, Nascimbene C, Vitulo P, Catanese C, Rota L, Barazzoni GC, Cornalba GP. Therapeutic embolization of bronchial artery: a successful treatment in 209 cases of relapse hemoptysis. Angiology. 1993;44:295-99.
Rabkin JE, Astafjev VI, Gothman LN, Grigorjev YG. Transcatheter embolization in the management of pulmonary hemorrhage. Radiology. 1987;163:361- 65.
Hayakawa K, Tanaka F, Torizuka T, Mitsumori M, Okuno Y, Matsui A, Satoh Y, Fujiwara K, Misaki T. Bronchial artery embolization for hemoptysis: immediate end long-term results. Cardiovasc Intervent Radiol. 1992;15:154-9.