# Case Report: Ectopic pulmonary embolism as a complication of bronchial artery embolization

## TL;DR

A patient with a rare lung condition developed a rare complication after a standard treatment for severe coughing up blood, highlighting the need for careful diagnosis.

## Contribution

This case highlights the risk of ectopic pulmonary embolism due to undiagnosed atypical fistulas during bronchial artery embolization.

## Key findings

- An ectopic pulmonary embolism occurred due to an undetected atypical fistula during bronchial artery embolization.
- The patient recovered after percutaneous catheter-directed embolectomy.
- Occult fistulas masked by multiple bronchial artery branches may increase embolism risk during BAE.

## Abstract

Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.