Direct visualization of postoperative aortobronchial fistula on computed tomography

Figure 6 Aortobronchial fistula in a 57-year-old asymptomatic man, a history of bronchioles 3 years earlier for a pseudoaneurysm after thoracoabdominal aorta replacement 16 years earlier for an aneurysm. Seven years after the first detection of peri-graft air, he developed fever and hemoptysis due to graft infection and a type 2 endoleak, and underwent aortic-arch-to-descending-aorta replacement, bronchopulmonary artery fistula closure, and intrathoracic omental repair. Ten years after the reoperation, the patient developed a pseudoaneurysm and underwent thoracic endovascular aortic repair (TEVAR). A: Initial computed tomography (CT) images show air shadow in the intra-aortic peri-graft space (arrow) and dilated peripheral bronchus (left B6) communicating with peri-graft air (arrow); B: Onset CT, 7 years after the initial CT images show increased peri-graft air (arrow), but there is no direct connection between bronchioles and peri-graft air. Axial enhanced CT demonstrates a Type 2 endoleak and ring enhancement; C: Latest CT, 18-year follow-up after initial CT images show residual peri-graft air and dilated peripheral bronchus (left B6) communicating with peri-graft air (arrow). No complications occurred during the follow-up period of 1.5 years after TEVAR for a pseudoaneurysm. DAo: Descending aorta; Lt: Left; MinIP: Minimum intensity projection.