Figure 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Endoscopic ultrasound showing (A) numerous foci of gas within the posterior mediastinal adenopathy adjacent to the esophagus and (B) a circular anechoic structure with visible Doppler flow seen endosonographically in the anterior mediastinum to the esophagus suggestive of a pseudoaneurysm.
Source publication
Bronchial artery pseudoaneurysms are an extremely rare cause of upper gastrointestinal bleeding. The presence of a bronchial artery pseudoaneurysm resulting in an esophageal fistula is an entity that, to our knowledge, has yet to be described. Successful management requires an interdisciplinary approach to guide closure of the defects. We present a...
Context in source publication
Context 1
... ultrasound (EUS) demonstrated a 13 3 15-mm circular anechoic structure in the mediastinum anterior to the esophagus with visible arterial Doppler flow suggestive of a pseudoaneurysm at the level of the subcarinal region, a small fistula in the middle third of the esophagus, and abnormal lymph nodes in the paratracheal region ( Figure 1). Immediately after EUS-fine needle aspiration of the lymph nodes via the transesophageal approach, endoscopy revealed gross blood in the middle third of the esophagus emanating from the fistulous tract along with a hiatal hernia and moderate-sized Schatzki ring. ...
Similar publications
A 59-year-old man received an incidental diagnosis of a 5-cm right para-aortic mass that was initially thought to be of venous origin. Multimodality imaging revealed a right bronchial artery pseudoaneurysm that was treated with endovascular embolization. Bronchial artery pseudoaneurysms are extremely rare and can be fatal if ruptured. (Level of Dif...
Citations
... It is difficult to be diagnosed by endoscopy and therefore, requires a high index of suspicion. Another type of AEF is subclavian artery-esophageal fistula which has been previously reported in few patients with prolonged nasogastric intubation and such patients should be screened for the possibility of an aberrant aortic arch system to avoid this fatal complication [4,5]. ...
Upper gastrointestinal bleeding is common and often needs timely intervention for optimal outcomes. Esophageal bleeding may occur due to local advancement of malignancy or bleeding from an arterio-oesophageal fistula. We discuss the management options available for such cases.
... Intrapulmonary bronchial artery aneurysm presents most commonly with hemoptysis. Whereas mediastinal bronchial artery aneurysm has more varied presentations including hemoptysis, dysphagia, dysphonia, hematemesis or hemoptysis if it ruptures into esophagus or airway [15] . ...
Bronchial artery aneurysm and pseudoaneurysm is a rare but life-threatening diagnosis due to catastrophic complications from rupture. Prompt detection and management is key to prevent complications. CT angiogram and digital subtraction angiography are preferred diagnostic imaging modalities. Being very uncommon, these entities can be misdiagnosed as a nonspecific mediastinal soft tissue mass, which can lead to delay in diagnosis and inappropriate or delayed management. We present a case of 72-year-old woman with incidentally detected large bronchial artery pseudoaneurysm, incorrectly classified as mediastinal malignancy at outside facility, receiving follow-up exams for 2 years, before correct diagnosis and management.
... Later on, two cases of BAAEFs successfully treated with RBA coil embolization have been reported [10,11]. In 2018, Nakada et al [12] reported a case of November 16, 2021 ...
Background:
Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery (RBA).
Case summary:
An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis. Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA, in the absence of active bleeding. Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach, in the absence of active bleeding or tumor ingrowth/overgrowth. After prompt multidisciplinary evaluation, a step-up approach was planned. The bleeding was successfully controlled by esophageal restenting followed by RBA embolization. No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.
Conclusion:
This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.
