CTICasesAortoesophageal Fistula
Imaging findings
CT of the abdomen and lower chest shows a massive volume of blood and blood clot within the stomach in a patient presenting with severe hematemesis. Sagittal reformats of the lower thoracic aorta demonstrate a subtle focal contour defect and connection between the anterior wall of the aorta and the adjacent gastroesophageal junction/stomach (fistula), developing several years after a laparoscopic paraesophageal hernia repair.
Key takeaways
Aortoesophageal or aortoenteric fistulas are rare, catastrophic vascular communications that carry a very high mortality. They can occur secondary to thoracic aortic aneurysms, foreign body ingestion, malignancy, or as a late complication of esophageal or diaphragmatic surgery (such as paraesophageal hernia repair). Prompt surgical or endovascular repair is required to prevent fatal exsanguination.
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