A fistula may rarely develop between esophagus and aorta. It can be followed by massive and typically fatal massive bleeding.


Risk factors for an aortoesophageal fistula:

(1) thoracic aortic aneurysm

(2) foreign body ingestion

(3) post-operative, after surgery to the esophagus or aorta

(4) malignancy, especially esophageal or lung carcinoma

(5) radiation therapy

(6) in theory, massive chemical burn


Clinical features - Chiari's triad:

(1) midthoracic chest pain

(2) sentinel arterial hemorrhage

(3) massive arterial exsanguinization with hematemesis after a symptom free interval that lasts from hours to days


The hemorrhage is bright red arterial blood.


Additional complaints:

(1) syncope

(2) hypotension and shock


Imaging studies:

(1) widened mediastinum depending on the underlying cause

(2) CT scan or MRI may demonstrate the precipitating cause or mediastinal air


Endoscopy is the best method for making the diagnosis but may precipitate massive hemorrhage, especially if the endoscopist tries to biopsy what appears to be an esophageal lesion. In addition, the bleeding may make visualization difficult.


Immediate surgery is the only therapy that can save the patient's life.


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