Direct visualization of postoperative aortobronchial fistula on computed tomography

Figure 3 Aortobronchial fistula in an asymptomatic 74-year-old woman, a history of thoracic endovascular aortic repair 1 year earlier for a pseudoaneurysm after replacement of a descending aorta 10 years earlier. Two years after the initial computed tomography (CT) scan, the patient developed fever and was diagnosed with a stent graft infection. Drainage of the peri-graft abscess was performed, and the infection was controlled, but the infection recurred repeatedly and was complicated by a Type 2 endoleak. At the latest CT scan, the patient had hemoptysis and fever. The patient died from massive hemoptysis 6 years after the initial CT. A: Initial CT images show air shadow in the intra-aortic peri-graft space (arrow) and dilated peripheral bronchi (left B1 + 2) communicating with peri-graft air (arrow); B: Onset CT, 2 years after the initial CT images show dilated peripheral bronchi (left B1 + 2 and B6) communicating with peri-graft air (arrow); C: Latest CT images show peri-graft dirty fat sign and disappearance of direct communication between peripheral bronchi and peri-graft air. CT angiogram demonstrates extravasation of contrast material into the native aneurysm, representing a Type 2 endoleak. Peri-graft fluid collection and ring enhancement are also seen. DAo: Descending aorta; TEVAR: Thoracic endovascular aortic repair; Lt: Left.