Major aorto-pulmonary collateral arteries (MAPCAs)--Bronchial fistula presenting as tracheotomy bleed

Area of Science:

• Pediatric Critical Care Medicine
• Thoracic Surgery
• Vascular Surgery

Background:

• Tracheal hemorrhage is a frequent complication in pediatric patients requiring long-term tracheotomy.
• Common causes include granulation tissue and suction trauma, which are typically self-limiting.
• However, tracheo-arterial fistula presents a rare but potentially fatal cause of tracheal bleeding.

Observation:

• A 21-month-old male with congenital cardiac malformations and tracheotomy dependence experienced recurrent, brisk bleeding from his tracheotomy tube.
• Initial presentation mimicked more common causes of tracheal hemorrhage.
• Diagnostic workup revealed an arterio-bronchial fistula originating from a major aorto-pulmonary collateral artery.

Findings:

• The patient was diagnosed with an arterio-bronchial fistula, a rare vascular complication in pediatric tracheotomy patients.
• This specific case involved an unusual etiology stemming from a major aorto-pulmonary collateral artery.
• Successful treatment was rendered for this life-threatening condition.

Implications:

• Highlights the importance of considering rare vascular etiologies like arterio-bronchial fistula in pediatric tracheotomy patients with severe hemorrhage.
• Emphasizes the need for prompt and accurate diagnosis to differentiate from common causes and initiate appropriate management.
• Contributes to the understanding of the pathophysiology and management strategies for this critical complication.