CTICasesAortotracheal Fistula
Imaging findings
A man in his 40s with tracheal squamous cell carcinoma treated with chemoradiation presented urgently with hemoptysis. CT shows a small tract of contrast arising from the aorta and extending to the tracheal margin, with surrounding soft tissue representing scarred, fibrotic mediastinal fat from prior radiation, and a small bronchial-artery diverticulum. He underwent a complex emergent hemi-arch repair with resection of the fistula, omental and pericardial coverage, and aortic reconstruction.
Key takeaways
Aortotracheal fistula is a rare and usually fatal complication, most often causing death from massive hemorrhage or air embolism before treatment. In this case radiation and tumor eroded the aorta against the trachea, and CT demonstrated a contrast tract bridging the aorta and airway. Emergent surgical repair with resection of the fistula and vascularized tissue coverage can be lifesaving in the uncommon patient who survives to intervention.
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