Yeungnam Univ J Med.  2020 Apr;37(2):141-146. 10.12701/yujm.2019.00444.

Effective strategy in the treatment of aortobronchial fistula with recurrent hemoptysis

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea

Abstract

Aortobronchial fistula (ABF) involves the formation of an abnormal connection between the thoracic aorta and the central airways or the pulmonary parenchyma and is associated with an increased risk of mortality. An ABF typically manifests clinically with symptoms of hemoptysis, and currently, there is a lack of defined guidelines for its treatment. Here, we report the cases of two patients who suffered from recurrent hemoptysis due to ABF with pseudoaneurysm. We propose that removal of the aorta with concomitant lung resection and coverage of the aorta using the pericardial membrane is a definite treatment to lower recurrence of ABF and persistent infection.

Keyword

Aorta; Endovascular procedure; Hemoptysis; Surgery

Figure

  • Fig. 1. Chest computed tomography (CT) findings. (A) Initial chest CT shows descending aortic pseudoaneurysm (arrow). (B) Two years later, chest CT reveals a newly formed type 1a endoleak (arrow) and an even larger pseudoaneurysm. (C) Chest CT on admission reveals type 1b endoleak (arrow) from the previous stent with progression of the pseudoaneury sm. (D) Lung consolidation with atelectasis (arrow).

  • Fig. 2. Postoperative chest radiograph and computed tomography (CT) findings of case 1. (A) Postoperative chest radiograph indicates a well-functioning Hemashield graft. (B) Postoperative chest CT indicates the absence of endoleaks (arrow). (C) Postoperative chest CT confirms the absence of a lung lesion.

  • Fig. 3. Chest computed tomography (CT) findings of case 2. (A) Initial chest CT indicates a pseudoaneurysm with a suspicious aortobronchial fistula lesion (arrow). (B) A follow-up chest CT reveals kinking stenosis of the aortic isthmus stent-graft (arrow). (C) Chest CT on admission reveals air entrapment within the thrombosed aneurysm (arrow). (D) Brochoscopy shows oozing at left upper lobe orifice (arrow).

  • Fig. 4. Postoperative chest radiograph findings of case 2. (A) Postoperative chest radiograph shows remnant stent-graft (arrow). (B) Postoperative chest radiograph (followed-up after 4 years) shows the abscence of lung lesion (arrow).


Reference

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