Massive haemoptysis in a patient with right pulmonary artery atresia with contralateral pulmonary artery pseudoaneurysm: a therapeutic dilemma in collateral-dependent pulmonary circulation.

A woman in her 30s presented with recurrent massive haemoptysis and chronic respiratory symptoms, including fever, cough and breathlessness. She had previously received empirical anti-tubercular therapy without microbiological confirmation or clinical improvement. CT angiography revealed right pulmonary artery atresia with extensive bronchial and non-bronchial systemic collaterals, a partially thrombosed pseudoaneurysm arising from a left lower lobe segmental branch with associated pulmonary infarction and bilateral bronchiectatic changes. She underwent embolisation of the pseudoaneurysm and selected systemic collaterals. Subsequently, she developed progressive hypoxaemic respiratory failure and succumbed to her illness. This case highlights delayed recognition of unilateral pulmonary artery atresia in adulthood and the challenge of controlling life-threatening haemoptysis while preserving pulmonary perfusion.