Systemic to pulmonary arterial fistula of the chest wall and lung following lobectomy
Syme, J.
Australasian Radiology 19(4): 326-333
1975
ISSN/ISBN: 0004-8461 PMID: 1225293 Document Number: 86550
The comparatively few cases on record of shunting of blood from systemic arteries of the chest wall to the pulmonary circulation are classified according to their parietal or pulmonary origin and listed chronologically. The clinical features, plain radiological findings, angiographic investigation and possible etiological mechanisms are reviewed, with particular reference to 5 of the group which followed a thoracic surgical procedure. The case is presented of a further fistula fed by multiple intercostal arteries and draining to pulmonary artery branches which complicated lobectomy. Particular reference is made to the plain film appearances of a local pulmonary lesion of vascular configuration and definite notching of adjacent ribs, a combination of findings not previously reported in a postoperative fistula. Stress is laid on the complementary roles of aortography, the definitive contrast study in this instance and pulmonary angiography in demonstrating the exact site of the shunt and its magnitude and its effect on the lesser circulation. The development of 2 separate foci of abnormal vascular communication, each at some distance from the level of the original thoracotomy, is a further hitherto unrecorded finding for a fistula complicating surgical interference.