Spontaneous Aortoesophageal Fistula And Ruptured Aortic Aneurysm - A Case Report On Combined Aortic And Esophageal Prosrhesis Palliative Treatment.

Aortoesophageal fistulas are uncommon, dreadful vascular events, most frequently found in the setting of thoracic aorta aneurysms. Patients usually present with thoracic pain, dysphagia and sentinel hematemesis - the Chiari triad - followed by life threatening hematemesis. Emergent open surgery with debridement of necrotic tissue and in situ aortic graft repair is currently the best strategy. However, in patients which cannot withstand surgery, endovascular repair is currently gaining acceptance as a palliative treatment or as a bridge to surgery. We present a case of a 55-year-old female with a past of heavy alcohol abuse and a previously unknown massive aortic aneurysm, who presented to the emergency department complai- ning of acute dysphagia and epigastric pain. An abdominal ultrasound revealed left pleural effusion and suspected clots in the pleural space. A thoracic CTA was promptly done, where a spontaneous ruptured aortic aneurysm with aortoesophageal fistula was discovered. The team, fearing open surgery due to poor cardiac function, opted for a thoracic endovascular aortic repair. The aortoesophageal fistula dissected the esophageal wall in all of its thickness without rupture into the lumen. This was complicated with esophageal ischemia, aneurysmal sac infection and mediastinitis. Because the patient was in shock, in order to help control the infection, an esophageal prosthesis was placed, followed by proximal esophagostomy, distal esophageal closure and gastrostomy. Six months after initial presentation, the patient died at the emergency room, shortly after reentering with massive hematemesis and hypovolemic shock of undetermined origin.

[Mycotic aneurysms: a case report, clinical review, imaging appearances and management].

To report a clinical case of mycotic thoracic aortic aneurysm. To describe and illustrate the spectrum of MDCT findings, analysing the pathophysiology, diagnostic evaluation and therapeutic management. To emphasis the early non-invasive diagnosis as a way to overall survival improvement. A mycotic aneurysm is an uncommon vascular lesion resulting from arterial wall destruction by infection, generally involving the peripheral arteries or aorta and rarely the cerebral and visceral arteries. Defined as a lobulated saccular outpouching of the wall communicating with the lumen, it is surrounded by oedema, hematoma and/or fibro-inflammatory tissue. Due the non-specific and delayed - or even absent - manifestations, a high degree of clinical suspicion is necessary to achieve a timely treatment and prognosis improvement. In this setting, radiologic evaluation - mainly by MDCT angiography - is essential, allowing detection, characterization and complications assessment before treatment planning.

Pretende-se reportar um caso clínico de aneurisma micótico da aorta torácica; descrever e ilustrar o espectro de achados tomodensitométricos (TDM); rever a fisiopatologia, a avaliação diagnóstica e o tratamento; e enfatizar o diagnóstico não-invasivo precoce como forma de aumentar a sobrevivência. Um aneurisma micótico é uma lesão vascular infrequente que resulta da destruição da parede arterial por um processo infecioso, que geralmente afeta as artérias periféricas ou a aorta, e, raramente, as artérias cerebrais ou viscerais. É definida como uma protrusão sacular e lobulada da parede em comunicação com o lúmen arterial, rodeada por edema, hematoma e/ou tecido inflamatório. Atendendo às manifestações inespecíficas e tardias que a caracterizam, é necessário um elevado grau de suspeição para que se obtenha um tratamento atempado e se possa melhorar o prognóstico. Consequentemente, a avaliação imagiológica ­ particularmente o estudo angiográfico TDM ­ é essencial, permitindo a deteção, caracterização e avaliação de complicações, necessárias ao planeamento terapêutico.