Major aorto-pulmonary collateral arteries (MAPCAs)--Bronchial fistula presenting as tracheotomy bleed.

Tracheal hemorrhage is a common occurrence in pediatric patients with long-term tracheotomies. The majority of these events are related to self-limited etiologies, such as granulation tissue or suction trauma. Tracheo-arterial fistula, however, represents a frequently fatal form of tracheal hemorrhage that may initially be difficult to distinguish from other causes.