An easily overlooked cause of haemoptysis and heart failure; anomalous systemic arterial supply to normal lung.

Systemic arterial supply to a segment of normal lung is rare. Usually the anomalous systemic artery arises from the descending aorta, although it can arise from other sites including the coeliac axis. Case reports documenting an anomalous artery to normal lung from the coeliac axis are few. However, in these cases the patients were being investigated for respiratory symptoms and all were under the age of 50. In our case, we describe a rare case of anomalous systemic arterial supply arising from the coeliac axis to the right lower lobe, in the absence of abnormal bronchial connection or parenchymal disease in an asymptomatic patient. The anomalous arterial supply was an incidental finding on CT. The literature suggests surgical treatment to prevent symptoms of haemoptysis or congestive cardiac failure, but it is unclear from current evidence whether this is indicated in an asymptomatic patient.