Aortobronchopulmonary fistula complicating aortic aneurysm: diagnosis in four cases

Aortobronchopulmonary fistula, a fistulous connection between the aorta and lung, is uniformly fatal in untreated cases. However, with early recognition and surgery, the survival rate exceeds 80%. We have had four patients with aortobronchopulmonary fistula, all of which resulted from thoracic aortic aneurysms (two after grafting of thoracic aortic aneurysms, one mycotic, one atherosclerotic). All four patients presented with hemoptysis. All four had a chest radiograph, which in two showed the aneurysm and in three showed airspace disease adjacent to the aorta. The aneurysm was shown by CT in one of two patients and by aortography in two of three patients. Neither CT nor aortography showed the fistula. Aortobronchopulmonary fistula was proved by surgery in two of the patients and by autopsy in the other two. A high index of suspicion is necessary to make the diagnosis of aortobronchopulmonary fistula. The diagnosis should be considered in patients who have minor or major hemoptysis, with either coexisting thoracic aortic aneurysms or history of thoracic aneurysm repair.