Aortopulmonary fistula

Associate Editor-In-Chief:

Overview
Aortopulmonary fistula is rare but has been thought to be uniformly fatal if not treated surgically. In the earlier experiences with this entity, a chronic infectious process arising in the lung or aorta was the most frequent cause. In recent decades, the reported aortopulmonary fistulas have occurred most frequently as the result of erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the lung.

Pathophysiology and Etiology

 * Complication of surgery or thoracic aortic graft
 * Indwelling chest tube, spinal fixation device, or foreign body
 * Erosion and/or rupture of a degenerative or false aneurysm of the distal aortic arch or descending thoracic aorta into the lung. Possible reasons of true or false aneurysms;
 * True aneurysm
 * Infectious aortitis
 * Aortic dissection
 * Traumatic aortic tear
 * Aortic suture line breakdown

Symptoms
The most frequent symptoms of an aortopulmonary fistula are chest pain and hemoptysis, but often shortness of breath, fever, and/or other respiratory symptoms are present.

Chest x-ray
Chest x-rays help to confirm pulmonary infiltrates.

Bronchoscopy
Bronchoscopy during an episode of hemoptysis can document its lobar origin.

Aortography
Aortography is a gold standard of diagnosing of aortopulmonary fistula. Subtraction technique may help to obtain additional information.

Treatment
Once the diagnosis is confirmed, prompt surgical or percutaneous interventions are indicated.


 * Endovascular stenting
 * Surgery