Aorto‑esophageal Fistula following Botox Injection

Abstract

Aorto‑esophageal fistulas (AEF) are rare, often fatal connections between the thoracic aorta and esophagus, arising from aortic disease, esophageal conditions, or iatrogenic causes. Case: A 76‑year‑old woman, treated for esophageal nutcracker syndrome with endoscopic injection of botox, developed chest pain and esophageal hemorrhage. Computed tomography (CT) confirmed an AEF from an aortic pseudoaneurysm. She succumbed to circulatory collapse before treatment. Discussion: Endoscopic botox injections are a rare cause of AEF. The diagnosis relies on imaging and endoscopy, with surgery often required. Teaching point: Aorto‑esophageal fistulas are rare, life‑threatening complications, particularly after iatrogenic procedures. Early diagnosis is crucial, but prognosis remains poor.

Keywords: Aorta; aorto‑esophageal fistula; botox; complication; esophagus.

Figure 1

Unenhanced CT showing a retrotracheal, paraortic hyperdense mass (star). There is a small discontinuity in the hyperdense aortic wall, representing the point of fistulation (arrow).

Figure 2

CT angiography showing contrast extravasation into the esophagus (star) from a fistula extending from the medial aspect of the aortic arch (arrow).

Figure 3

Three‑dimensional (3D) volume‑rendering technique (VRT) image of the CTA in sagittal orientation showing the fistula (arrow) between the aneurysm (An) and contrast material within the esophagus. Aorta (Ao). Esophagus (white stars).