Tsuchiya Nanae, Inafuku Hitoshi, Yogi Satoko, Iraha Yuko, Iida Gyo, Ando Mizuki, Nagano Takaaki, Higa Shotaro, Maeda Tatsuya, Kise Yuya, Furukawa Kojiro, Yonemoto Koji, Nishie Akihiro
Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan.
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan.
World J Radiol. 2024 Aug 28;16(8):337-347. doi: 10.4329/wjr.v16.i8.337.
Postoperative aortobronchial fistula (ABF) is a rare complication that can occur in 0.3%-5.0% of patients over an extended period of time after thoracic aortic surgery. Direct visualization of the fistula imaging is rare.
To investigate the relationship between computed tomography (CT) findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.
Six patients (mean age 71 years, including 4 men and 2 women) with suspected ABF on CT (air around the graft) at our hospital were included in this retrospective study between January 2004 and September 2022. Chest CT findings included direct confirmation of ABF, peri-graft fluid, ring enhancement, dirty fat sign, atelectasis, pulmonary hemorrhage, and bronchodilation, and the clinical course were retrospectively reviewed. The proportion of each type of CT finding was calculated.
ABF detection after surgery was found to have a mean and median of 14 and 13 years, respectively. Initial signs and symptoms were asymptomatic in 4 patients, bloody sputum was found in 1 patient, and fever was present in 1 patient. The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients. Of the 6 patients, 3 survived, 2 died, and 1 was lost to follow-up. The locations of the ABFs were as follows: 1 in the ascending aorta; 1 in the aortic arch; 2 in the aortic arch leading to the descending aorta; and 2 in the descending aorta. ABFs were directly confirmed by CT in 4/6 (67%) patients. Peri-graft dirty fat (4/6, 67%) and peri-graft ring enhancement (3/6, 50%) were associated with graft infection, endoleaks and pseudoaneurysms were associated with hemoptysis (2/6, 33%).
Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT. CT is useful for the diagnosis of ABF and its complications.
术后主动脉支气管瘘（ABF）是一种罕见的并发症，在胸主动脉手术后的较长一段时间内，发生率为0.3%-5.0%。通过影像学直接观察到瘘管的情况很少见。
探讨胸主动脉手术后计算机断层扫描（CT）表现与ABF临床体征/症状之间的关系。
本回顾性研究纳入了2004年1月至2022年9月期间我院6例CT检查怀疑有ABF（移植物周围有气体）的患者（平均年龄71岁，包括4名男性和2名女性）。胸部CT表现包括ABF的直接确诊、移植物周围积液、环形强化、脏脂肪征、肺不张、肺出血和支气管扩张，并对临床病程进行回顾性分析。计算每种CT表现的比例。
术后ABF的发现时间平均为14年，中位数为13年。4例患者初始体征和症状无症状，1例患者出现血痰，1例患者发热。ABF的并发症包括2例移植物感染和2例移植物感染伴咯血。6例患者中，3例存活，2例死亡，1例失访。ABF的位置如下：升主动脉1例；主动脉弓1例；主动脉弓至降主动脉2例；降主动脉2例。4/6（67%）的患者通过CT直接确诊为ABF。移植物周围脏脂肪（4/6，67%）和移植物周围环形强化（3/6，50%）与移植物感染相关，内漏和假性动脉瘤与咯血相关（2/6，33%）。
胸主动脉手术后无症状的ABF可通过胸部CT确诊。CT对ABF及其并发症的诊断有用。
