# Challenges in diagnosis and management of aortobronchial fistula: a case report

## TL;DR

This case report discusses the challenges in diagnosing and managing a rare condition called aortobronchial fistula, emphasizing the importance of early detection and multidisciplinary care.

## Contribution

The paper presents a rare case of aortobronchial fistula and highlights the diagnostic and therapeutic challenges associated with it.

## Key findings

- Aortobronchial fistulas often present with haemoptysis and can be life-threatening if not treated.
- Tranexamic acid showed clinical improvement but bleeding recurred after discontinuation.
- Endovascular treatment is a viable option for managing contained ruptures in high-risk patients.

## Abstract

Aortobronchial fistulas (ABFs) are rare but potentially life-threatening conditions, often presenting with haemoptysis. They can develop following various thoracic aortic conditions or procedures.

A 70-year-old patient with a history of descending aorta replacement and ischaemic stroke presented with chest pain and upper gastrointestinal bleeding. Imaging revealed a fistula between the aortic prosthesis and the lung, along with other cardiovascular abnormalities. Despite the indication for anticoagulant therapy, tranexamic acid was initiated due to bleeding risk. The patient showed clinical improvement with tranexamic acid treatment but experienced recurrence of bleeding after discontinuation. Endovascular treatment for the contained rupture at the proximal stent anastomosis was indicated.

Haemoptysis is the primary symptom of ABFs, often recurring until the fistula enlarges. Postoperative aortic fistulas into the airways are uncommon and can occur years after surgery. Thoracic endovascular aortic repair has become the primary treatment for high-risk patients with thoracic aortic disease. Various diagnostic modalities can visualize a fistula tract, but practical visualization is rare. Untreated ABFs invariably lead to death.

This case highlights the challenges in diagnosing and managing ABFs, emphasizing the need for a multidisciplinary approach and regular follow-up. Patient education and prompt reporting of symptoms are essential. Early intervention upon suspicion of recurrence is crucial for optimizing patient outcomes.