A Case of Bronchial Artery Hypertrophy Complicated By a Broncho-Pulmonary Arterial Fistula, Presenting With Submissive Hemoptysis

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

INTRODUCTION: Bronchial artery hypertrophy (BAH) is a rare condition characterized by dilated and tortuous bronchial arteries (>2 mm in diameter), .This condition can arise from chronic inflammatory lung diseases, such as asthma, COPD tuberculosis, or from conditions that impair pulmonary blood flow, like chronic thromboembolic disease. BAH may result in hemoptysis, a potentially life-threatening complication due to the fragility of the enlarged, thin-walled arteries, which are prone to rupture and bleeding into the airways. CASE PRESENTATION: 35-year-old male with history of asthma, bronchial artery hypertrophy s/p bronchial artery embolization 3 years back presented with shortness of breath and hemoptysis. He had a recent history of RSV bronchitis. In the ER he was hypoxic and required 3-4 L of oxygen by nasal cannula . CTA PE showed multifocal patchy opacities and diffuse mucus plugging of the right mainstem bronchus extending into the right middle and lower lobe. Bronchoscopy showed significant bleeding in the right main stem, bronchus intermedius, right middle lobe and right lower lobe bronchus. Patient underwent bronchial arteriogram and IR guided embolization that failed to achieve complete hemostasis due to presence of a fistula connecting the bronchial artery to the pulmonary artery. Post embolisation patient was weaned off to room air . Thoracic surgery was consulted and patient was planned for a right lower lobe resection. DISCUSSION: Bronchial artery hypertrophy is a known complication in asthma, occurring as a response to chronic airway inflammation and constriction. The bronchial arteries dilate and thicken to maintain adequate blood supply to the lung tissue, leading to hypertrophy. This hypertrophy can contribute to airway hyper-responsiveness and increase the risk of bleeding during severe asthma exacerbations.. The bronchial arteries communicate with the pulmonary artery, pulmonary vein, and azygos vein, as well as their branches and tributaries. Fistulas between these vessels are often associated with conditions such as severe chronic obstructive pulmonary disease (COPD), malignancy, pulmonary fibrosis, trauma, radiation therapy, and complications from pulmonary catheterization (e.g., Swan-Ganz insertion). In our case bronchial artery hypertrophy was present in the same area as the mucous plugging, indicating the likely mechanism of increased pressure and inflammation in the local bronchial arterial system. Prior embolisation 3 years ago may have created a subclinical complication that developed into broncho-pulmonary arterial fistula noted during the aforementioned hospitalization. CONCLUSIONS: Bronchial artery hypertrophy should be considered a differential in patients with obstructive lung disease (complicated by frequent exacerbations ) presenting with hemoptysis.

Volume

168

Issue

4S

First Page

6816A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

Last Page

6816A

DOI

10.1016/j.chest.2025.07.3821

Link to Full Text

Share

COinS