Bronchial systemic-artery-to-pulmonary-artery-fistula as mimicker of pulmonary embolism: computed tomography findings verified with bronchial artery angiography

We present the case of an 81-year-old patient, who was transferred to our department for diagnostic work-up and treatment of hemoptysis of the right lung. Two-phase contrast-enhanced chest CT revealed filling defects in right upper lobe and middle lobe pulmonary artery during the pulmonary-artery phase who vanished in the subsequent aortographic phase, consistent with systemic-artery-to-pulmonary-artery fistulas (SA-PAFs) of right bronchial artery mimicking pulmonary embolism. Selective bronchial catheter-arteriography confirmed bronchial SA-PAFs and bronchial artery embolization was performed effectively and without complication. For the best of our knowledge, this is the first case of a bronchial systemic-artery-to-pulmonary-artery-fistula mimicking PE directly correlated and proved with bronchial artery angiography.