Aortobronchial fistula: keys to successful management.

Aortobronchial fistula is a rare but highly lethal condition. If diagnosed, its survival rates are greater than 80%; if not, the condition is uniformly fatal with death most commonly due to massive hemoptysis. A review of the world's literature and an illustrated case are presented. A total of 30 cases have been described, but the published incidence may be low. Of the cases presented to sufficient detail for analysis, 92% (23 of 25) were associated with an aneurysm of the thoracic aorta. The most consistent symptom was hemoptysis (22 of 23, 96%), especially massive hemoptysis (15 of 19, 79%). Plain chest radiographs demonstrated an aneurysm in 46% (6 of 13 evaluable cases). Either an aneurysm on the chest x-ray or massive hemoptysis, or both were seen in 94% of cases (16 of 17). The most rewarding test (in 5 of 7, 71%) was the thoracic aortogram. Surgical correction was followed by an 82% survival rate (9 of 11). Untreated, the eventual mortality was 100%, although one patient died as late as 6 months after the initial presentation with massive hemoptysis.