Hoarseness as a first manifestation of aortotracheal fistula

Aortotracheal fistula is uncommon but invariably fatal if not diagnosed early and accurately. Most fistulas are related to aneurysm of the thoracic aorta. Massive hemoptysis is reported to occur in more than half of the patients and is often the final event. We report a patient with hoarseness as an initial manifestation due to the painless formation of a pseudoaneurysm of aortic arch, which soon ruptured. Bronchoscopy disclosed a tracheal bulging mass with surface irregularity on the distal end of trachea before massive hemoptysis. We thought, faced with the cardiovocal syndrome accompanied with hemoptysis, lethal aortopulmonary fistula should be highly suspected.