Aortopulmonary fistula
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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 (pneumonitis or abcess or aorta (mycotic aneurysm [1] 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 left lung.[2] [3] [4] [5] [6] [7]
Pathophysiology and Etiology
- Complication of surgery or thoracic aortic graft [8]
- 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;
Diagnosis
Signs And 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.[13] [14]. It can also presents with dyspnea, chest discomfort on exertion and other symptoms of congestive heart failure.[15] A person can have bounding pulse, prominent precordium, palpable thrill and murmur.
Chest x-ray
Chest x-rays help to confirm pulmonary infiltrates. It can show widened mediastinum with pulmonary plethora.
Echocardiogram
Echo can show dilation of aorta and increased flow of pulmonary artery.
Aortogram
It can show dilation of aorta and the fistulous communication between aorta and main pulmonary artery.
CT
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.
References
- ↑ https://www.medscape.com/viewarticle/410487. Missing or empty
|title=(help) - ↑ Killen D.A, Aortopulmonary Fistula, South Med J 93(2), 2000
- ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
- ↑ Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177
- ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
- ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
- ↑ Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of post traumatic chronic aortic aneurysm. AJR 1995; 164:1511-1513
- ↑ Jones J: Complications of the surgery of patent ductus arteriosus. J Thorac Surg 1947; 16:305-313
- ↑ Coblentz C, Sallee D, Chiles C: Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases. AJR 1988; 150:535-538
- ↑ DeProphetis N, Armitage H, Triboletti E: Rupture of tuberculous aortic aneurysm into lung. Ann Surg 1959; 150:1046-1051
- ↑ Fernandez Gonzales A, Montero J, Luna D, et al: Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. Tex Heart Inst J 1996; 23:174-177
- ↑ Szolar D, Riepl T, Stiskal M, et al: Aortobronchial fistula as a late complication of posttraumatic chronic aortic aneurysm. AJR 1995; 164: 1511-1513
- ↑ MacIntosh E, Parrott J, Unruh H: Fistulas between the aorta and tracheobronchial tree. Ann Thorac Surg 1991; 51:515-519
- ↑ Favre J, Gournier J, Adham M, et al: Aortobronchial fistula: report of three cases and review of the literature. Surgery 1994; 115:264-270
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763467/. Missing or empty
|title=(help) - ↑ Miyata T, Ohara N, Shigematsu H, et al: Endovascular stent graft repair of aortopulmonary fistula. J Vasc Surg 1999; 29:557-560
- ↑ Campagna A, Wehner J, Kirsch C, et al: Endovascular stenting of an aortopulmonary fistula presenting with hemoptysis. J Cardiovasc Surg 1996; 37:643-646
- ↑ Lawrence W, Kern J, Tribble C: Repair of aortobronchial fistula using extraanatomic grafts and hypothermic arrest. Ann Thorac Surg 1997; 63:1158-1160