Post-Traumatic Aortic Arch Aneurysm Complicated by Aorto-Pulmonary Fistula

Abstract

We report a rare case of presumed post-traumatic aortic arch aneurysm complicated by an aorto-pulmonary artery fistula. Contrast-enhanced computed tomographic pulmonary angiography completed by dynamic cardiac magnetic resonance imaging allowed adequate preoperative visualization of an 8-mm large fistula between the aneurysm and the left pulmonary artery. The patient underwent successful total aortic arch replacement and closure of the fistula using a patch.

Keywords: Aortic aneurysm; Aorto-pulmonary fistula; Computed tomography scan; Magnetic resonance imaging scan.

Figure 1.

Contrast-enhanced computed tomographic pulmonary angiography showing a fistula between the aortic arch aneurysm and the origin of the left pulmonary artery (arrows). A. Axial view passing through the pulmonary bifurcation. B. Sagittal oblique view passing through the aortic arch. Note the contrast agent jet (same density as seen in the aorta) in the left pulmonary artery, suggesting a left-to-right shunt through the fistula.

Figure 2.

Dynamic cardiac MRI for evaluation of the aorto-pulmonary fistula using cine-steady-state-free-precession sequence at the same levels as seen on computed tomography. Note the high-velocity shunt through the fistula between the aortic arch aneurysm and the left pulmonary artery.