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Li L, Lao YH. Massive Hemoptysis Caused by an Aortobronchial Fistula Related to Pedicle Screw Impingement. Vasc Endovascular Surg 2021; 55:761-765. [PMID: 33759646 DOI: 10.1177/15385744211005656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a 50-year-old man with a 10-year history of pedicle screw internal fixation in the thoracic spine and heroin abuse, who presented with sudden-onset massive hemoptysis with hemorrhagic shock and asphyxia. Urgent contrast-enhanced chest computed tomography (CT) characteristically showed thoracic aortic perforation, a paravertebral pseudoaneurysm, and an intrapulmonary hematoma. Emergency percutaneous thoracic endovascular aortic repair (pTEVAR) with the preclose technique using a vascular closure device under local anesthesia achieved success without any complications. The current case highlights the importance of understanding massive hemoptysis caused by an aortobronchial fistula related to pedicle screw impingement in clinical practice and the value of pTEVAR with the preclose technique under local anesthesia in the emergency setting.
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Affiliation(s)
- Long Li
- Division of Interventional Radiology, Department of Medical Imaging, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou, China
| | - Yong-Hao Lao
- Division of Interventional Radiology, Department of Medical Imaging, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou, China
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Byard RW. Causes of sudden death related to oesophageal carcinoma. MEDICINE, SCIENCE, AND THE LAW 2021; 61:69-72. [PMID: 32990174 DOI: 10.1177/0025802420962353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Two cases of recently diagnosed oesophageal squamous-cell carcinomas in men, both aged 72 years, are reported that resulted in rapid clinical deterioration and death from upper-airway occlusion and haemorrhage, respectively. In the first case, direct growth of the tumour from metastatic deposits in the paratracheal lymph nodes through the wall of the trachea resulted in lethal acute airway occlusion. In the second case, local extension of the tumour through the wall of the oesophagus into the adjacent aorta resulted in an aorto-oesophageal fistula which led to catastrophic and fatal haemorrhage. Although rare, oesophageal squamous-cell carcinomas may cause unexpected death due to quite different mechanisms, and result in the need for a detailed medico-legal assessment.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and School of Medicine, The University of Adelaide, Australia
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Son SA, Lee DH, Kim GJ. Patch aortoplasty and anatomical lung resection in a patient with aortobronchial fistula due to aortic psuedo-aneurysm. Indian J Thorac Cardiovasc Surg 2020; 36:416-419. [PMID: 33061152 DOI: 10.1007/s12055-020-00939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
Aortobronchial fistula (ABF) is a rare and devastating complication, if left untreated. Its main clinical manifestation is hemoptysis, and there are no defined guidelines for its treatment yet. Herein, we present the case of a 74-year-old male who complained of back pain and hemoptysis. The patient was diagnosed with pseudo-aneurysm and ABF, and he underwent hybrid thoracic endovascular aortic repair. However, hemoptysis recurred. With patch aortoplasty and anatomical lung resection, successful management of ABF was achieved, with no relapse for 5 years.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, South Korea
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Son SA, Lee DH, Kim GJ. Effective strategy in the treatment of aortobronchial fistula with recurrent hemoptysis. Yeungnam Univ J Med 2020; 37:141-146. [PMID: 32131081 PMCID: PMC7200220 DOI: 10.12701/yujm.2019.00444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
Aortobronchial fistula (ABF) involves the formation of an abnormal connection between the thoracic aorta and the central airways or the pulmonary parenchyma and is associated with an increased risk of mortality. An ABF typically manifests clinically with symptoms of hemoptysis, and currently, there is a lack of defined guidelines for its treatment. Here, we report the cases of two patients who suffered from recurrent hemoptysis due to ABF with pseudoaneurysm. We propose that removal of the aorta with concomitant lung resection and coverage of the aorta using the pericardial membrane is a definite treatment to lower recurrence of ABF and persistent infection.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
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Abstract
Aortobronchial fistulas (ABFs) are rare but fatal if left untreated. Hemoptysis is the most common symptom of the patients. ABFs may occur after any thoracic aortic lesions or maneuveurs for these lesions. The treatment of ABF can be surgical or thoracic endovascular aortic repair. Thoracic endovascular aortic repair can be a safe and less invasive procedure for the treatment of ABFs. However, ABFs might occur in much shorter time after thoracic endovascular aortic repair than any other etiologies. The prognoses of patients with ABFs are poor with a high morbidity and mortality. The selection of a suitable endovascular graft and avoidance of postinterventional complications might effectively prevent the occurrence of ABFs.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
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Stephenson L, Byard RW. An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy. Forensic Sci Med Pathol 2019; 16:143-151. [PMID: 31471869 DOI: 10.1007/s12024-019-00161-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.
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Affiliation(s)
- Lilli Stephenson
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia.
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Durmić T, Savić S, Bogdanović M. Aortopulmonary fistula related death - forensic implications. Forensic Sci Med Pathol 2019; 15:485-487. [PMID: 31028574 DOI: 10.1007/s12024-019-00114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 11/26/2022]
Abstract
A 79-year-old man with a history of arterial hypertension, insulin-dependent diabetes mellitus, renal insufficiency and thoracic endovascular aortic repair (TEVAR) was brought to the emergency department, following an episode of oliguria and urine retention. During chest X-ray he suddenly collapsed and died. Autopsy revealed a large atherosclerotic saccular thoracic aortic aneurysm whose right lateral wall firmly adhered to the right lung. There was more than 2.5 l of blood with fibrin deposits in the right part of the thoracic cavity. The right bronchus contained a cast of blood; blood was also present in the trachea and the distal airways of the right lung. Further dissection revealed that the aneurysm had eroded the tissue surrounding it and made a fistulous canal into the lower lobe of the right lung, causing the lung to fill with fluid blood. The cause of death was hemorrhage from the aortopulmonary fistula caused by pressure necrosis from the thoracic aortic aneurysm.
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Affiliation(s)
- Tijana Durmić
- Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia.
| | - Slobodan Savić
- Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - Milenko Bogdanović
- Institute of Forensic Medicine "Milovan Milovanović", School of Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
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Versnaeyen H, Saey V, Vermeiren D, Chiers K, Ducatelle R. Intermittent Haemoptysis due to an Aortobronchial Fistula in a Warmblood Mare. J Comp Pathol 2016; 155:213-217. [PMID: 27535296 DOI: 10.1016/j.jcpa.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/03/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
A 7-year-old warmblood mare showed sudden onset of mild intermittent haemoptysis. Clinical examination revealed no significant abnormalities. Haematological examination showed mild anaemia, hypoalbuminaemia and neutrophilia. Coagulation tests were normal. Endoscopic examination revealed unilateral pulmonary haemorrhage with blood clots in the bronchi and trachea. Treatment with antibiotics was started and the horse was given stable rest. Two weeks later, the horse was found dead with blood and frothy sputum leaking from the nostrils. Post-mortem examination revealed a large thoracic aortic aneurysm communicating with a pseudoaneurysm that had formed a fistula into a right bronchial branch. Microscopical examination of the aneurysm showed extensive medial fibrosis with prominent degeneration, fragmentation and mineralization of the elastic fibres and deposition of mucoid material in the tunica media. The pseudoaneurysm was lined by collagen bundles admixed with fibroblasts and a small amount of adipose tissue. Aortobronchial fistula is a rare condition in man that is usually associated with primary aortic pathology, most often aneurysms. To the authors' knowledge this is the first case of a fatal aortobronchial fistula in a horse or any other animal species.
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Affiliation(s)
- H Versnaeyen
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Belgium.
| | - V Saey
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Belgium
| | - D Vermeiren
- Veterinary Practice, Perbeemd, Sint-Lenaartseweg 67, Loenhout, Belgium
| | - K Chiers
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Belgium
| | - R Ducatelle
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Belgium
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Prost A, Boudry J, Bronquard M, Bauge JP, Chavanon O. Hémoptysie de faible abondance au cours d’un syndrome aortique aigu. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-013-0374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thu M, Winskog C, Byard RW. Tuberculosis and sudden death. Forensic Sci Med Pathol 2013; 10:266-8. [DOI: 10.1007/s12024-013-9501-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/24/2022]
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