Aortobronchial fistulas

Aortobronchial fistulas are a rare and life-threatening complication seen in pulmonary tuberculosis, staphylococcal pneumonia, bronchogenic lung cancer, aortic dissection without aneurysm, thoracic aortic aneurysm, and mycotic aneurysms, and after aortic valve replacement, repair of aortic coarctation, and unilateral lung transplantation.

Patients with aortobronchial fistula most commonly present with recurrent or massive hemoptysis. Intermittent hemoptysis is attributed to thrombus formation in the fistulous tract which stops the hemoptysis. With clot lysis or dislocation, a new episode of hemoptysis begins. Most aortobronchial fistulas are large enough to produce massive hemoptysis and immediate death. Patients may also present with cough, dyspnea, and chest pain, which are non-specific signs and are often misleading. Aortobronchial fistula should be considered in the differential diagnosis of hemoptysis, particularly in the presence of a thoracic aortic aneurysm.

Diagnosis should be confirmed with a dynamic CT scan or angiography. Bronchoscopy may result in the displacement of thrombus in the fistulous tract or perforation of the aneurysm, leading to exsanguination.

Surgical repair is the only definitive lifesaving therapy for aortobronchial fistula. Delay in the diagnosis and treatment results in a fatal outcome. Surgery is aimed at excision of the fistula and repair or replacement of the aorta. Sometimes resection of the adjacent lung is necessary.

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