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.
