Aortobronchial Fistula: A Rare Etiology for Hemoptysis

Abstract

Aortobronchial fistula is an extremely rare cause of hemoptysis. Aortobronchial fistula occurs in patients who have a history of thoracic vascular surgery. Because its symptoms are nonspecific, a high index of suspicion is critical if the physician is to detect it. The results of imaging studies (e.g., plain films, computed tomography, and angiography) and bronchoscopy are sometimes, but not always, diagnostic—another reason the diagnosis is difficult. Left untreated, mortality in patients with aortobronchial fistula is 100%. Patients can be salvaged by a variety of techniques, including the placement of an endovascular stent. We describe the case of a 52-year-old man who came to us with hoarseness and hemoptysis, which proved to be underlying symptoms of aortobronchial fistula. He was treated successfully.

Staged Management of a Primary Aortobronchial Fistula: A Novel Approach Using a Trapezius Flap Repair

“…Aortobronchial fistulas arise as a complication of an aneurysm or pseudoaneurysm, which can be attributed to a number of aetiologies. These aetiologies include infection, atherosclerosis, postsurgical repair of the aneurysm or trauma [4].…”

“…Aortobronchial fistulas have a high rate of morbidity and if left untreated have a 100% mortality rate [4].…”

“…Imaging studies such as chest film, CT scan, and angiography as well as bronchoscopy are not always diagnostic for aortobronchial fistulas, however CT angiography imaging is probably the best screening test [3,4]. Chest X-ray findings are usually nonspecific (e.g., infiltrates, masses, consolidation and presence of pleural fluids) and show an aneurysm in only about 50% of cases [4].…”

“…Chest X-ray findings are usually nonspecific (e.g., infiltrates, masses, consolidation and presence of pleural fluids) and show an aneurysm in only about 50% of cases [4]. Bronchoscopy can show the source of bleeding but the fistulous tract may not be visible [4].…”

“…Chest X-ray findings are usually nonspecific (e.g., infiltrates, masses, consolidation and presence of pleural fluids) and show an aneurysm in only about 50% of cases [4]. Bronchoscopy can show the source of bleeding but the fistulous tract may not be visible [4]. On CT, an aortic aneurysm and the ground-glass appearance of the adjacent lung suggests there exists an aortobronchial fistula, however the fistula itself is not usually seen [4].…”