Case Reports Hemoptysis Due To Thoracic Aortic Pathologies and Aortobronchial Fistulas

Aortobronchial fistula (ABF) is a communicating tract between the aort and the bronchial tree. ABF is a rare but fatal complication of aortic pathologies. The major symptom is recurrent or massive hemoptysis. Although ABF may occur by opening of the aneurysmal sac into the lung parenchyma, it can also be encountered in pseudoaneurysms that develop after surgical repair of the aneurysms, coarctation of the aorta and patent ductus arteriosus. The aim of this study is to evaluate the outcome of the patients with ABF.
METHOD
Between January 1991 and December 1997, ABF w as diagnosed in s ix patients in o ur center. Our cases consisted of four males and two females with an average age of 39±12 years. Descending aortic aneurysms were found in 4 of the cases. One of the other patients had been operated for coarctation of the aorta and had tube graft interposition in 1975. One patient had Bentali operation for the ascending aortic aneurysm in 1991. ABF was found secondary to pseudoaneurysms developed at the proximal anastomosis of the former, and at the distal anastomosis of the latter. Four of the patients were operated by us. Surgical approach was performed through the left posterolareral thoracotomy. In one patient left atrio femoral bypass was used. In another patient cardiopulmonary bypass was applied via main pulmonary artery and left femoral artery. Two cases were operated on with simple aortic damping. We used sutureless aortic tube graft in one patient, woven velour vascular graft patch in one, and a tube graft in one case.
RESULTS
The patient who had Bentali operation died due to multiorgan failure preoperatively. One patient was lost due to sudden rupture of the aneurysm before the operation. One of the four operated cases died during the operation. The other 3 cases were discharged succesfully and are doing fine.
CONCLUSION
ABF is a serious complication of the pathologies of the thoracic aorta and, as soon as diagnosed, surgical treatment must be performed. Differential diagnosis of hemoptysis is vitally important.