Rupture of a thoracic aneurysm in the left bronchus

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. Thereafter, he developed an aortic isthmic dilation (36 mm in diameter). The patient suffered from long standing pulmonary insufficiency and emphysema and was admitted several times on an urgent basis for acute dyspnea. During an hospitalization for respiratory distress, he presented haemoptysis and left lung hyperinflation secondary to partial fistulization and extrinsic compression of the main left bronchus. Isthmic aortic resection and prosthetic grafting was performed and the left main bronchus was closed by an autologous pericardial patch. Ten days later, following an air-leak from the bronchial closure, a transposed latissimus dorsi flap was used by the plastic surgeon to repair the defect. Nevertheless, the patient died from multisystemic failure six weeks later.