Coronary Bronchial Steal

Background: Most patients with coronary-bronchial fistulas are asymptomatic. However, some patients present with congestive heart failure, infective endocarditis, myocardial ischemia induced by a coronary steal phenomenon, or rupture of an aneurysmal fistula. Our case of coronary-bronchial steal presented with massive hemoptysis and anginal pain. Methods: CT scan chest showed an emphysematous bulla and focal bronchiectatic changes involving right upper lobe. Coronary angiography revealed a large fistula connecting left circumflex coronary artery to right bronchial artery. A covered stent was placed in proximal left circumflex artery and collaterals excluded. Result: His angina resolved and dyspnea improved. Hemoptysis reduced from about 500 ml per day to about 50 ml a day, in ten days. 6-month follow-up has been uneventful without recurrence of angina or hemoptysis. Conclusion: This report highlights the importance coronary angiography in detecting coronary artery abnormalities in patients with hemoptysis. Although previously treated with surgical ligation, interventional therapies are justifiably becoming more widely used to correct vascular insufficiencies.