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Case report
Rare broncho-pulmonary arterial fistula in a healthy 9-year-old girl
  1. Nicholas Avdimiretz1,
  2. Amy Glicksman2,
  3. Sharon Dell3,
  4. Philip John4 and
  5. Theo J Moraes3
  1. 1Pediatric Respirology, Stollery Children's Hospital, Edmonton, Alberta, Canada
  2. 2Pediatrics, Humber River Hospital, Toronto, Ontario, Canada
  3. 3Pediatric Respirology, Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4Interventional Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Nicholas Avdimiretz; naa1{at}


A 9-year-old previously well girl presented with multiple episodes of large volume haemoptysis and right sided consolidation. She continued to have haemoptysis despite intravenous antibiotics. CT chest suggested a right mainstem endobronchial lesion; this was not seen on bronchoscopy where an extensive blood clot was removed. Distal flexible bronchoscopy could not identify the source of bleeding. CT angiogram revealed a broncho-pulmonary arterial fistula, a rare cause of haemoptysis in children. Endovascular embolisation resulted in short-term symptom resolution; however, haemoptysis recurred months later, leading to re-embolisation. This case highlights a stepwise approach to the workup of large volume haemoptysis.

  • respiratory medicine
  • paediatrics
  • interstitial lung disease

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  • NA and AG are joint first authors.

  • Contributors NA contributed to the planning, literature review, drafting, editing, and submission of this work. AG generated the idea for publication, and contributed equally to the planning, case review, drafting, and editing of this work. SD contributed to the planning, drafting, and editing of this work. PJ contributed by planning, editing, and obtaining angiography. TM contributed to the planning, drafting, and editing of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.