Thoracic aortic aneurysm with aortobronchial fistula: a thirteen-year experience

PURPOSE: This study investigated the causes of aortobronchial fistula, clinical features, diagnostic modalities, and prognostic factors. PARTICIPANTS: A retrospective analysis of 17 patients with aortobronchial fistula secondary to thoracic aortic aneurysm was studied. METHODS: Retrospective chart review was used. RESULTS: Atherosclerosis (47.1%), infection (23.5%), and previous thoracic vascular surgery (17.6%) accounted for most causes. Most patients (94.1%) experienced at least 1 episode of hemoptysis. Chest computer tomography is the most useful tool and revealed hematoma or consolidation around the aneurysm in more than half of our patients. Bronchoscopy and aortoangiogram frequently did not demonstrate an aortobronchial fistula. The 6 patients in the surgery group all survived, in contrast to 100% mortality in the non-surgery group. The average interval between initial presentation of hemoptysis and surgical intervention in the surgery group is 68 days, in contrast to 170 days between initial presentation of hemoptysis and death in the non-surgery group. CONCLUSIONS: A high index of suspicion will decrease delayed diagnosis. Early diagnosis and emergent surgery are 2 prognostic factors for survival.