Burns Dean, Vijayasankar Dhakshinamoorthy
Peterborough City Hospital, Peterborough, UK.
Frontline Gastroenterol. 2011 Jul;2(3):151-152. doi: 10.1136/fg.2010.004119. Epub 2011 Feb 12.
Thoracic aortic dissection (TAD) with aorto-oesophageal fistula formation is an uncommon but fatal cause of haematemesis. A case is presented of a previously healthy 63-year-old man who presented to the emergency department with syncope and haematemesis. He had no history of heavy alcohol intake and was previously well. Bedside portable chest x ray revealed a widened mediastinum and, while awaiting a CT angiogram, he had a further large haematemesis which led to him undergoing resuscitation and rapid sequence intubation. CT angiography of his thoracic aorta revealed a large thoracic aortic aneurysm with dissection from the arch of the aorta down to the left iliac artery. The dissection had formed an aorto-oesophageal fistula in the proximal oesophagus. He was transferred to a tertiary referral centre for repair of the dissection and aorto-oesophageal fistula.
胸主动脉夹层（TAD）合并主动脉食管瘘形成是一种罕见但可导致呕血的致命病因。本文报告一例病例，患者为一名63岁既往健康男性，因晕厥和呕血就诊于急诊科。他无大量饮酒史，之前身体状况良好。床边便携式胸部X线检查显示纵隔增宽，在等待CT血管造影期间，他再次大量呕血，随后接受了复苏和快速顺序插管。其胸主动脉CT血管造影显示一个巨大的胸主动脉瘤，从主动脉弓向下至左髂动脉均有夹层。夹层在食管近端形成了主动脉食管瘘。他被转至三级转诊中心进行夹层修复及主动脉食管瘘修复。
