Aortobronchial fistula: report of three cases and review of the literature.

BACKGROUND

Aortobronchial fistula is uniformly fatal if not treated surgically. The aim of this study is to report three new cases and to discuss cause, clinical findings, surgical approaches, and results.

METHODS

All three patients with massive hemoptysis underwent operation in emergency situation. The procedure performed were a Bentall operation for a false aneurysm of the ascending aorta 10 years after the correction of an acute dissection, a Dacron graft replacement for a mycotic aneurysm of the descending aorta, and an extraanatomic bypass between ascending and celiac aortas for a false aneurysm 14 years after the correction of an isthmic coarctation.

RESULTS

The patient with the mycotic aneurysm died of paraplegia and septicemia after operation. The other two were without symptoms after 2 years of follow-up.

CONCLUSIONS

The diagnosis should be considered in any patient with minor or major hemoptysis and prior history of thoracic aortic operation. Aortography and thoracic computed tomographic scan are the main investigations for diagnosis. Direct approach or extraanatomic bypass have the same results with a survival rate of 76% in the recent literature. Early diagnosis and emergency surgery are the two predictive factors for good results.