PMC3037993_01
Chest X-ray showing development of a right-sided empyema in the patient.
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F1
Despite treatment with intravenous antibiotics, an empyema subsequently developed (fig. 1), presumably because the bronchial fistula had been adequately sealed with the stents, creating an undrained collection in the lung which subsequently fistulated through to the pleural cavity.
Endoscopic images. a A large arterial bleeding point (arrow), just above the proximal end of the stent in the mid-esophagus. The jet of blood, which was reckoned to be almost 2 mm in diameter, goes from the bottom left hand corner to the middle of the top left hand quadrant. b A 28 mm diameter Niti-S covered esophageal stent (Taewong Medical, Seoul, Korea) was inserted to tamponade the bleeding point.
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F2
Its clearance identified a large arterial bleeding point, just above the proximal end of the stent in the mid-esophagus (fig. 2a). A further 28 mm diameter Niti-S covered esophageal stent (Taewong Medical, Seoul, Korea) was inserted to tamponade the bleeding point (fig. 2b).
CT angiography images. a An aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum. The esophagus is filled with old clot without contrast, indicating successful tamponade of the fistula. b An endoluminal vascular stent (COOK TX2 36 mm x 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis.
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F3
CT angiography was performed and demonstrated an aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum (fig. 3a). Repeat CT angiography confirmed haemostasis (fig. 3b).