PMC9213657_01
Preoperative examinations. (A) Computed tomography angiography (CTA): coronal view of mediastinitis and aortoesophageal fistula. Mediastinitis and gas accumulation with the green circle. The white arrow points to the leakage of contrast from the aorta, indicating a break in the aortic wall, within a small red circle. (B) Three-dimensional CT showed a break in the aortic wall (big red circle points to the aortic breakage).
fsurg-09-916006-g001.jpg
PMC9213657_01_fsurg-09-916006-g001.jpg
F1
The computed tomography (CT) images revealed bilateral pulmonary infection and pleural effusion, as well as mediastinitis with gas within the mediastinum (Figure 1A). The findings of three-dimensional CT and aortic computed tomography angiography (CTA) confirmed a fistula of the aortic arch (Figure 1).
Postoperative images. (A and B) different views of three-dimensional computed tomography angiography (CTA): complete sealing of the break in the aortic wall after thoracic endovascular aortic repair (TEVAR). (C,D) Transverse view: complete sealing of the break in the aortic wall, no contrast agent extravasation was observed around the stent after TEVAR; bilateral pleural effusions were seen mainly on the right side. (E,F) Axial contrast-enhanced CT image after mediastinal debridement and drainage with cervical incision and video-assisted thoracoscopic surgery: the stent and drainage tube were observed clearly, with no fluid on both sides of the chest.
fsurg-09-916006-g002.jpg
PMC9213657_01_fsurg-09-916006-g002.jpg
F2
The post-operative CTA showed that the aortic stent was successfully placed and no leakage of contrast agents was found around the stent (Figure 2A-D). On day 11, post-operative contrast-enhanced CT revealed bilateral pleural effusion disappeared, and the drainage tube and the stent were observed clearly (Figure 2E-F).
Postoperative upper digestive tract iodine angiography. (A,B) Esophageal walls were intact, without contrast agent leakage.
fsurg-09-916006-g003.jpg
PMC9213657_01_fsurg-09-916006-g003.jpg
F3
On day 21, an upper digestive tract iodine angiography was performed and confirmed the esophageal fistula had healed (Figure 3), and the patient was switched to tube feeding combined with oral enteral nutrition.