title: Major aorto-pulmonary collateral arteries (MAPCAs)--Bronchial fistula presenting as tracheotomy bleed.
abstract: Tracheal hemorrhage is a common occurrence in pediatric patients with long-term tracheotomies. The majority of these events are related to self-limited etiologies, such as granulation tissue or suction trauma. Tracheo-arterial fistula, however, represents a frequently fatal form of tracheal hemorrhage that may initially be difficult to distinguish from other causes. Previous reports have described the pathophysiology, presentation and management of tracheo-arterial fistula involving the innominate artery. We describe a case of a 21-month-old male with a history of significant congenital cardiac malformations and chronic tracheotomy tube dependence who presented with intermittent, brisk bleeding from the tracheotomy tube. He was ultimately diagnosed with and treated for an arterio-bronchial fistula from a major aorto-pulmonary collateral artery. We review the etiology and management of this disorder.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Johnson
authors.forename: Abtin
authors.initials: A
authors.lastname: Tabaee
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Fitz-James
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
authors.forename: Lianne M
authors.initials: LM
authors.lastname: de Serres
mesh_terms: D001011:Aorta / Q000002:abnormalities; D001983:Bronchial Fistula / Q000175:diagnosis*; D003097:Collateral Circulation; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008168:Lung / Q000098:blood supply*; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities; D014133:Tracheal Diseases / Q000175:diagnosis*; D014140:Tracheotomy; D016157:Vascular Fistula / Q000175:diagnosis*