CTICasesAortoesophageal Fistula from Nasogastric Intubation with Aberrant Aortic Arch
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Imaging findings
A patient had a right-sided aortic arch with an aberrant left subclavian artery, likely a variant of a double arch with an atretic segment, forming a vascular ring. This caused some mass effect and posterior indentation on the trachea. After prolonged endotracheal and nasogastric intubation, she presented with massive upper GI hemorrhage, and endoscopy showed fresh blood in the esophagus. Imaging suggested an aortoesophageal fistula related to the aberrant vessel's course.
Key takeaways
While generally benign, aberrant aortic arches (e.g., right-sided arch with aberrant left subclavian artery forming a vascular ring) can rarely predispose to catastrophic complications such as aortoesophageal fistula. This risk is significantly increased by prolonged nasogastric intubation, which can cause chronic irritation and erosion, leading to a fatal outcome.
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