Haemodynamic changes due to systemic arterial shunts in a destroyed lung mimicking pulmonary thromboembolism on CT.

To cite: Paruthikunnan SM, Narayanan R, Abhishek A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015211746 DESCRIPTION A 51-year-old woman presented to our department with multiple episodes of massive haemoptysis. She had a history of pulmonary tuberculosis. High-resolution CT scan showed a completely destroyed right lung with fibrocavitatory changes (figure 1). CT pulmonary and bronchial angiography was performed, which showed non-enhancement of the right pulmonary artery in the pulmonary angiographic phase, leading to suspicion of a pulmonary arterial embolus (figure 2). The bronchial angiographic phase showed brilliant enhancement of the right pulmonary artery and its branches through reversed filling via multiple systemic collaterals arising from the hypertrophied right bronchial, right intercostal and right inferior phrenic arteries (figure 3). In patients with chronic pulmonary parenchymal inflammation, such as bronchiectasis, pulmonary