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Ann Thorac Surg 1991;51:515-519
© 1991 The Society of Thoracic Surgeons

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Articles

Fistulas between the aorta and traceobronchial tree

Department of Surgery, University of Manitoba and the Health Sciences Centre, Winnipeg, Manitoba, Canada

^_* Address reprint requests to Dr Unruh, Respiratory Hospital, RS115-810 Sherbrook St, Winnipeg, Manitoba R3A 1R8, Canada.

Aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. With appropriate surgical intervention, survival rates greater than 70% can be achieved. A review of the literature and an illustrative case report are presented. A total of 63 fistulas in 62 patients have been described. The case we present is unusual in the use of serratus anterior muscle for repair of the fistula. Eighty-seven percent of the cases documented in the literature were associated with an aneurysm of the thoracic aorta. Eighty-six percent of the fistulas were between the descending aorta and left bronchopulmonary tree. More than 95% of patients experienced at least a single episode of hemoptysis, and massive hemoptysis occurred in more than half of the reported cases. A correct preoperative diagnosis was made in only 54% of cases. Plain chest radiographs definitively demonstrated an aneurysm in only 16%. The computed tomographic scan was the most rewarding test, identifying an aneurysm in 11 of 12 patients and the fistula in 50% of them. Surgical repair resulted in a 76% survival rate.

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