Death due to a bronchus-pulmonary artery fistula developed 19 years after radiotherapy: A forensic autopsy case...

Radiotherapy, one of the standard therapies for lung cancer management, may cause severe late complications. In this case report, we describe the forensic autopsy report of a middle-aged man who died from a massive hemoptysis due to a bronchus-pulmonary artery fistula that developed 19 years after radiotherapy. The man, in his 50 s, suddenly developed hemoptysis at home and collapsed. He was in complete remission with no signs of recurrence. Autopsy revealed massive hemorrhage from the bronchus-pulmonary artery fistula, where radiotherapy had been focused. Histopathological findings showed chondronecrosis of the bronchus, disruption of elastic fibers of the pulmonary artery, and marked thickening of the intima of the small arteries around the fistula, which were compatible with radiation reaction. Neither cancer recurrence nor infection was evident. This case suggests that a late complication of radiotherapy should be considered in the differential diagnosis of a patient who was previously received radiotherapy and presents with massive hemoptysis. In such cases, a detailed history on previous therapies and careful examination of the origin of hemorrhage are necessary to determine the cause of death.