Elsevier

Heart & Lung

Volume 33, Issue 2, March–April 2004, Pages 119-123
Heart & Lung

Issues in pulmonary nursing
Thoracic aortic aneurysm with aortobronchial fistula: a thirteen-year experience

https://doi.org/10.1016/j.hrtlng.2003.12.008Get rights and content

Abstract

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.

Introduction

Aortobronchial fistula (ABF) is an anomalous communication between the aorta and a segment of the tracheobronchial tree. The majority of the fistulas are related to an aneurysm of the thoracic aorta.1 The leading causes have been reported to be previous thoracic vascular surgery (60%), infection (26%), atheroscelrosis (11%), and trauma (3%), in descending order.2

In spite of using various diagnostic tools including chest radiography, computer tomography (CT) scan, bronchoscopy, and echocardiography, it may be difficult to demonstrate the tract of aortobronchial fistula.3 Because the correct diagnosis of aortobronchial fistula is established premortem in only 44% to 56% of cases,4 the frequency is most likely underestimated. We conduct a retrospective study to survey the etiology and clinical features of aortobronchial fistula to compare the various diagnostic modalities and to analyze the outcome.

Section snippets

Materals and methods

We retrospectively reviewed the records of patients with a clinical diagnosis of aortobronchial fistula secondary to thoracic aortic aneurysm at the Kaohsiung Chang Gung Memorial Hospital, a tertiary referral center in Taiwan. Between 1988 and 2001, 17 patients were identified. Two patients died of massive hemoptysis before performing CT scanning or bronchoscopy examination. The other 15 patients met the criteria as follows: chest CT scan showed aortic aneurysm with peiaortic hematoma and

Results

Seventeen consecutive patients with aortobronchial fistulas secondary to thoracic aortic aneurysm were enrolled in our study. Demographic as well as clinical information and outcomes of 17 patients with aortobronchial fistula are summerized in Table I. There were 12 men (71%) and 5 women (29%), with a mean age of 65.5 years (range, 50 to 78 years). Nine patients (64.8%) had a history of hypertension. Six patients (35.3%) had known aortic dissection or aneurysm. Two of them had undergone

Discussion

The 3 leading causes of ABF in this study were atherosclerosis (47.1%), infection (23.5%), and previous thoracic vascular surgery (17.6%). This rank is somewhat different from that of the previous review,2 which identified the leading causes of ABF as previous thoracic vascular surgery, infection, atherosclerosis, and trauma, in descending order. This difference may be attributed to: (1) underestimation of the frequency of aortobronchial fistulas, which led to death but was not confirmed with

References (16)

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