AB 67. Successful endovascular management of massive hemoptysis secondary to aortobronchial fistula, ten years after thoracic aorta traumatic rupture

Background: Hemoptysis, secondary to aortobronchial fistula, is a rare and potentially fatal condition. We present a case report of noninvasive endovascular treatment of hemoptysis due to aortobronchial fistula, in a patient with a history of thoracic aorta traumatic rupture.

Patients and methods: A 55-year-old man presented with massive hemoptysis and a 2-month history of recurrent hemoptysis. Ten years previously, the patient had undergone thoracic aortic interposition of Dacron graft as a surgical repair of thoracic aorta traumatic rupture. Despite the severity of bleeding, the patient was haemodynamically stable. Spiral computed tomography angiography of the thorax revealed a saccular pseudoaneurysm of thoracic aorta of about 4.2 cm in diameter at the level of the previous aortic repair. The computed tomography examination also revealed alveolar infiltrations and a ground-glass appearance in the adjacent left upper lobe, indicative of extravasation to the lung parenchyma.

Results: Under the impression of aortobronchial fistula, a digital angiography was immediately performed. It confirmed the diagnosis and an endovascular tubular graft Gore TAG was interposed via femoral approach. The bleeding ceased gradually and the patient was discharged free of symptoms. At the 1-month and 2-month follow up, the CT revealed an improvement of the infiltrations and a decrease of the pseudoaneurysm size.

Conclusions: Aortobronchial fistula should be included in the differential diagnosis in patients with hemoptysis and even a long history of thoracic aorta traumatic rupture. Endovascular stenting seems to represent a safe, non invasive therapeutical option. Early diagnosis, prompt management and long term follow up maybe proved lifesaving.