Chen Zhujun, He Jian, Huang Qin, Liang Peiqiang, Gong Liang, Pi Qiangzhong
Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Army Medical University (Southwest Hospital) Chongqing China.
Respirol Case Rep. 2024 Oct 14;12(10):e70047. doi: 10.1002/rcr2.70047. eCollection 2024 Oct.
Oesophagomediastinal fistula is uncommon. Oesophageal fistulas, may manifest as recurrent pneumonias. While pulmonary infections can lead to pulmonary artery pseudoaneurysms (PAPs), particularly in fungal infections. PAPs pose a rupture risk, potentially causing life-threatening hemoptysis. We report a unique case of a 45-year-old male who presented with sudden cough, dyspnea, and hemoptysis. Bronchoscopy triggered massive hemoptysis, necessitating emergency embolization. Persistent hemoptysis prompted further imaging, revealing an aneurysmal dilation located next to the spine and infectious lesions, suggesting an oesophagomediastinal fistula. After initiating therapy with Amphotericin B Cholesterol Sulfate Complex and fistula closure, the patient's hemoptysis resolved, with imaging resolution of the PAP. Long-term Voriconazole therapy ensured continued improvement. This case highlights the rarity and severity of such fistulas may be associated with fungal infections and PAPs, emphasizing the importance of prompt recognition, aggressive treatment for favourable outcomes.
食管纵隔瘘并不常见。食管瘘可能表现为反复肺炎。虽然肺部感染可导致肺动脉假性动脉瘤（PAPs），尤其是在真菌感染时。PAPs有破裂风险，可能导致危及生命的咯血。我们报告了一例独特病例，一名45岁男性，出现突发咳嗽、呼吸困难和咯血。支气管镜检查引发大量咯血，需要紧急栓塞。持续咯血促使进一步影像学检查，发现脊柱旁有动脉瘤样扩张及感染性病变，提示食管纵隔瘘。在用两性霉素B胆固醇硫酸酯复合物治疗并封闭瘘管后，患者咯血停止，PAP在影像学上消失。长期伏立康唑治疗确保病情持续改善。该病例突出了此类瘘管的罕见性和严重性，可能与真菌感染及PAPs有关，强调了及时识别、积极治疗以获得良好预后的重要性。
