https://orcid.org/0000-0001-5870-237X
A 36-year-old woman was referred for transthoracic echocardiography due to resistant arterial hypertension.
Colour Doppler echocardiography from the suprasternal window showed a turbulent flow inferior to the aortic arch (Panel A, white arrow and see Supplementary data online, Video S1). Pulsed wave Doppler examination revealed a biphasic waveform with continuous forward flow throughout diastole (Panel B) that suggested an aortopulmonary fistula. Nevertheless, there were no signs of high flow state nor an anomalous flow in the pulmonary artery.
A thoracic computed tomography (CT) disclosed an enlarged and twisted arterial branch arising from the aortic arch (Panels C and D, white arrow) and directed towards the right bronchus (Panel C, yellow asterisk), compatible with an ectopic and hypertrophic right bronchial artery.
The right bronchial artery usually arises from the third posterior intercostal artery, but an ectopic origin is present in 20% of patients, including the aortic arch and subclavian or internal thoracic arteries. Bronchial artery hypertrophy is associated with chronic inflammatory lung pathology or cyanotic congenital heart conditions, but it is exceedingly rare in the general healthy population, as in our patient.
Our case provides an unusual explanation for continuous forward flow in an aortic branch, resembling an aortopulmonary fistula. Complementary examination with CT is mandatory for the differential diagnosis.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
Funding: None declared
Data availability: The authors confirm that the data supporting the findings of this case are available within the article and its supplementary materials.
Author notes
Conflict of interest: None declared.
