Aortobronchial fistula (ABF)

The aorta is the largest artery in the body. It rises from the heart's left ventricle (the major chamber that pumps blood out of the heart) filled with oxygen-rich blood that travels throughout the body. When the connection is between the aorta and the tracheobronchial tree — the branchlike structure that supplies air to the lungs — it is known as an aortobronchial fistular (ABF).

Symptoms

The main symptom of ABF is coughing up blood or bloodstained mucus from the lungs, a condition known as hemoptysis. Other symptoms of the condition include:

  • A mass near the aorta
  • Back pain
  • Chest pain
  • Shock

The main symptom that can cause the most harm, and even death, is hemoptysis. Without immediate medical treatment the patient may suffocate due to blood filling up the lungs.


Causes and Risk Factors

This rare condition is most often the result of previous surgical graft treatment for aortic coarctation or a chronic aortic aneurysm. It is fatal if left untreated.

Diagnosis

Diagnosis of ABF generally begins with the physician taking a medical history and performing an emergency physical examination. A chest X-ray is also used to make an initial diagnosis if the patient is coughing up blood.

If the chest X-ray shows a mass near the aorta, a bronchoscopy is often performed. The bronchoscope is a flexible, hollow tube that is inserted through the mouth or nose and into the bronchi (windpipes). The procedure, which can help the medical team determine the location of the ABF, may be performed under light sedation or a general anesthetic.

Other imaging tests include a transesophageal echocardiography, a type of echocardiography that uses an ultrasound probe inserted through the esophagus; an MRI scan, a CT scan or an aortic angiogram. Some of the diagnostic imaging tests require a special dye to be injected into the vein so that it shows up more clearly on the images.

Treatments

Because ABF is a life-threatening condition, treatment is needed immediately and is usually in the form of emergency surgery.

During surgery, the graft from the previous operation on the aorta will be removed in the event that it is causing chronic inflammation to the area. The opening of the fistula is then closed, either with a new graft or by stitching together the two sides. The method of closure will depend on the size of the opening. If the condition is caught early and treated surgically, it has a survival rate of over 80 percent.

The knowledgeable and highly trained staff at the Cedars-Sinai Heart Institute will work with each patient to determine the best treatment option.