PMC5410481_01
A chest radiograph on admission showed bilateral infiltrates.
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A chest radiograph showed bilateral infiltrates (Fig. 1).
Computed tomography showed multiple consolidation and ground glass opacities.
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A chest CT further demonstrated multiple consolidations and ground glass opacity and focal bronchiectasis in right segment 4 (S4) (Fig. 2).
A: A high-resolution computed tomography (CT) image showing focal bronchiectasis in the right middle lung (S4). B: CT angiography showing a vessel entering the bronchiectasis lesion arising from the right inferior phrenic artery. C: Three-dimensional CT depicting the right inferior phrenic artery-to-right pulmonary artery fistula.
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CT, which showed bronchiectasis in right S4 and regression of the infiltration. CTA revealed an abnormal vascular anastomosis between the right inferior phrenic artery and right pulmonary artery beside the focal bronchiectasis at the right middle lobe (Fig. 3), which led us to suspect it as the possible source of the massive hemoptysis.
Right inferior phrenic artery angiogram confirmed the right inferior phrenic artery-to-right pulmonary artery fistula (arrow) in an intrapulmonary portion.
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We therefore performed embolization by superselecting the right inferior phrenic artery with a 2.2-Fr. microcatheter (Fig. 4).