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Ann Thorac Surg 2000;69:640
© 2000 The Society of Thoracic Surgeons

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Images in Cardiothoracic Surgery

Aortobronchial fistula

^a Department of Cardiothoracic Surgery, The Mount Sinai–NYU Medical Center, New York, New York, USA

Address reprint requests to Dr Ergin, Department of Cardiothoracic Surgery, The Mount Sinai–NYU Medical Center, One Gustave L. Levy Place, PO Box 1028, New York, NY 10029

An 82-year-old man with known saccular aneurysm of the descending aorta presented with massive hemoptysis. Computed tomographic scan showed a descending aortic aneurysm, 7 cm in diameter, and infiltration of the left lung with contrast material (Fig 1). The patient was taken to the operating room immediately. His chest was entered through a left posterolateral thoracotomy. The aneurysm was mobilized posteriorly by sacrificing the intercostic arteries from thoracic fifth to ninth. Manipulation of the pulsating lung parenchyma was avoided. After administration of 100 units/kg heparin, descending aorta proximal to the aneurysm and left femoral artery were cannulated. A centrifugal pump with reservoir was used for lower body perfusion. The aorta was clamped proximal and distal to the aneurysm. Resection and graft replacement of the descending aortic aneurysm and en-bloc left lower lobectomy was carried out (Fig 2). The fistula size was 3 x 2 cm (Fig 3). A pathologic examination showed that left lower lobe airways were filled with blood and the aneurysm was atherosclerotic. The patient developed temporary agitation and confusion after extubation. He was discharged 12 days after the operation and has remained asymptomatic for 10 months of follow-up. An early elective operation should be performed for aortic aneurysms to prevent their life threatening complications like aortobronchial fistula, which requires prompt surgical intervention.

View larger version (148K): [in this window] [in a new window]   Fig 1. Computed tomographic scan showing a 7-cm descending aneurysm and infiltration of the left lung with contrast material.

View larger version (87K): [in this window] [in a new window]   Fig 2. En-bloc left lower lobe and aortic aneurysm wall around the fistula.

View larger version (102K): [in this window] [in a new window]   Fig 3. Aortobronchial fistula orifice sizing 3 x 2 cm.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anil Z. Apaydin Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Apaydin, A. Z. Articles by Ergin, M. A. Search for Related Content PubMed PubMed Citation Articles by Apaydin, A. Z. Articles by Ergin, M. A.