title: Management of an intrabronchial rupture of right main pulmonary artery: a case report.
abstract: We report a case of massive endobronchial hemorrhage following a fistula formation of the right pulmonary artery to the right mainstem bronchus in a 15-year-old girl. The fistula had occurred 39 days after the patient had undergone bilateral lung transplantation for cystic fibrosis. The post-transplantation course was remarkable for bronchial colonization by Aspergillus at the site of right bronchial anastomosis and an episode of spontaneous, self-limited hemoptysis on postoperative day 17. A massive endobronchial hemorrhage during surveillance bronchoscopy occurred 39 days after transplantation. Immediate intervention, including rigid bronchoscopy followed by surgery, was effective in saving the patient. The pathophysiologic hypothesis to explain the fistula of the right pulmonary artery to the right mainstem bronchus probably involves ischemia of the anastomosis with necrosis of the suture zone complicated by endobronchial infection with Aspergillus. Rigid bronchoscopic intervention associated with an excellent medical surgical collaboration was pivotal in successfully rescuing the patient.
authors.affiliation: Département des Maladies Respiratoires et Center Laser, Hôpital Sainte-Marguerite, Marseilles, France. CPINET@mail.ap-hm.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Pinet
authors.forename: Wojciech
authors.initials: W
authors.lastname: Palka
authors.forename: Dominique
authors.initials: D
authors.lastname: Metras
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Bernard
authors.initials: B
authors.lastname: Méric
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dumon
mesh_terms: D000293:Adolescent; D001230:Aspergillus / Q000302:isolation & purification; D001980:Bronchi / Q000382:microbiology; D001983:Bronchial Fistula / Q000150:complications*; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D011651:Pulmonary Artery; D016157:Vascular Fistula / Q000150:complications*