Baron R L, Koehler R E, Gutierrez F R, Forrest J V, Weyman P J
Radiology. 1981 Dec;141(3):599-605. doi: 10.1148/radiology.141.3.7302210.
Aneurysms of the thoracic aorta simulated primary esophageal disease both clinically and radiographically in 5 patients. Four had an aortoesophageal fistula at the time of presentation; endoscopic biopsy of a presumed esophageal tumor precipitated hematemesis in the fifth patient. In retrospect, the fistulas were demonstrated by barium esophagography in 3 patients. In 3, arteriography showed the aortic aneurysm but failed to reveal the fistula. The literature confirms a similar presentation for most other aortoesophageal fistulas, with premonitory esophageal bleeding followed hours to days later by massive hemorrhage. Of the reported cases of rupture of aneurysms of the thoracic aorta, 12% bled into the esophagus. While clinical and radiographic distinction between primary esophageal disease and esophageal manifestations of an aortic aneurysm is occasionally difficult, it is crucial for proper management.
5例胸主动脉瘤在临床和影像学上均模拟原发性食管疾病。4例在就诊时存在主动脉食管瘘；第5例患者在对疑似食管肿瘤进行内镜活检后引发了呕血。回顾性分析发现，3例患者通过食管钡餐造影显示出瘘管。3例患者经动脉造影显示有主动脉瘤，但未发现瘘管。文献证实，大多数其他主动脉食管瘘也有类似表现，先是有先兆性食管出血，数小时至数天后出现大出血。在报告的胸主动脉瘤破裂病例中，12%的病例血液流入食管。虽然原发性食管疾病与主动脉瘤的食管表现之间的临床和影像学鉴别偶尔会有困难，但这对正确的治疗至关重要。
