Bronchial artery-pulmonary artery fistula with pulmonary embolism and massive hemoptysis: a rare case report and literature review.

Background: Bronchial artery-pulmonary artery fistula is a rare vascular anomaly, either congenital or acquired due to recurrent infections. When associated with pulmonary embolism and massive hemoptysis, it significantly increases the risk of mortality and poses complex therapeutic challenges. Only two such cases have been reported in the literature based on PubMed and CNKI database. Anticoagulation therapy requires careful management to balance thrombotic and hemorrhagic risks. Case presentation: A 60-year-old male who presented with recurrent massive hemoptysis was diagnosed with a bronchial artery-pulmonary artery fistula and pulmonary embolism, confirmed by computed tomography pulmonary angiography and digital subtraction angiography. Hemostasis was achieved through bronchial artery embolization, followed by individualized anticoagulation therapy with warfarin, adjusted according to INR monitoring. Conclusion: This case underscores the importance of a personalized diagnostic and therapeutic approach in managing the coexistence of vascular fistula, pulmonary embolism, and hemoptysis. Bronchial artery embolization remains the cornerstone of acute bleeding control, while a carefully tailored and closely monitored anticoagulation strategy is essential to reduce thrombotic risk without increasing the likelihood of hemorrhagic complications.