Tsuchiya N, Inafuku H, Yogi S, Iraha Y, Iida G, Ando M, Nagano T, Higa S, Maeda T, Kise Y, Furukawa K, Yonemoto K, Nishie A. Direct visualization of postoperative aortobronchial fistula on computed tomography. World J Radiol 2024; 16(8): 337-347 [DOI: 10.4329/wjr.v16.i8.337]
Corresponding Author of This Article
Nanae Tsuchiya, MD, PhD, Lecturer, Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-Cho, Nakagami-Gun, Okinawa 903-0215, Japan. nanaeasygoing@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nanae Tsuchiya, Satoko Yogi, Yuko Iraha, Gyo Iida, Akihiro Nishie, Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan
Hitoshi Inafuku, Mizuki Ando, Takaaki Nagano, Shotaro Higa, Tatsuya Maeda, Yuya Kise, Kojiro Furukawa, Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan
Koji Yonemoto, Department of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Author contributions: Tsuchiya N and Nishie A contributed to conceptualization; Tsuchiya N, Yonemoto K, Furukawa K and Nishie A contributed to methodology; Inafuku H, Ando M, Maeda T, Nagano T, Higa S, Kise Y, and Furukawa K contributed to clinical data analysis; Yogi S, Iida G and Iraha Y contributed to image analysis; Tsuchiya N and Yonemoto K contributed to statistical analysis; Tsuchiya N writing original draft preparation; Inafuku H, Yonemoto K, Furukawa K and Nishie A contributed to writing, review and editing; All authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee for Clinical Research of University of the Ryukyus with waiver of informed consent (No. 24-2278-00-00-00).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nanae Tsuchiya, MD, PhD, Lecturer, Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-Cho, Nakagami-Gun, Okinawa 903-0215, Japan. nanaeasygoing@gmail.com
Received: May 23, 2024 Revised: August 6, 2024 Accepted: August 15, 2024 Published online: August 28, 2024 Processing time: 96 Days and 23.6 Hours
Abstract
BACKGROUND
Postoperative aortobronchial fistula (ABF) is a rare complication that can occur in 0.3%-5.0% of patients over an extended period of time after thoracic aortic surgery. Direct visualization of the fistula via imaging is rare.
AIM
To investigate the relationship between computed tomography (CT) findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.
METHODS
Six patients (mean age 71 years, including 4 men and 2 women) with suspected ABF on CT (air around the graft) at our hospital were included in this retrospective study between January 2004 and September 2022. Chest CT findings included direct confirmation of ABF, peri-graft fluid, ring enhancement, dirty fat sign, atelectasis, pulmonary hemorrhage, and bronchodilation, and the clinical course were retrospectively reviewed. The proportion of each type of CT finding was calculated.
RESULTS
ABF detection after surgery was found to have a mean and median of 14 and 13 years, respectively. Initial signs and symptoms were asymptomatic in 4 patients, bloody sputum was found in 1 patient, and fever was present in 1 patient. The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients. Of the 6 patients, 3 survived, 2 died, and 1 was lost to follow-up. The locations of the ABFs were as follows: 1 in the ascending aorta; 1 in the aortic arch; 2 in the aortic arch leading to the descending aorta; and 2 in the descending aorta. ABFs were directly confirmed by CT in 4/6 (67%) patients. Peri-graft dirty fat (4/6, 67%) and peri-graft ring enhancement (3/6, 50%) were associated with graft infection, endoleaks and pseudoaneurysms were associated with hemoptysis (2/6, 33%).
CONCLUSION
Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT. CT is useful for the diagnosis of ABF and its complications.
Core Tip: This retrospective study included six patients with aortobronchial fistula based on computed tomography (CT) findings of peri-graft air, with aortobronchial fistula being detected a mean of 14 years after thoracic aortic surgery. Asymptomatic aortobronchial fistula can be confirmed on chest CT as direct communication between dilated peripheral bronchi and peri-graft air. CT is useful for the diagnosis of aortobronchial fistula and its complications.
