A Case of Secondary Aortopulmonary Fistula with Inflammatory Esophageal Polyp following Thoracic Endovascular Aortic Repair

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  • 大動脈瘤が原因と考えられる炎症性食道ポリープを認めたTEVAR 後大動脈肺瘻の1 例

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The patient, a 70-year-old man who underwent thoracic endovascular aortic repair and total aortic arch replacement for descending aortic aneurysm, presented our hospital with chief complaints of hemoptysis and fever. Computed tomography showed air entrapment around the stent-graft. Esophagoscopy showed a mucosal elevation due to extrinsic compression by the descending aorta, an inflammatory polyp, and an orifice-like lesion on the lower esophageal lumen adjacent to the aortic aneurysm. Suspecting an aortoesophageal fistula, the operation was performed. Intraoperative findings revealed an aortopulmonary fistula in the left lower lobe; however, an aortoesophageal fistula was not found. Thus, resection of the whole infected stent-graft, graft replacement of the descending aorta, and omental wrapping were performed. Postoperative esophagoscopy showed disappearance of the inflammatory polyp and the presence of a scar tissue at the same site. The disappearance of the inflammatory polyp on the lower esophageal lumen adjacent to the aortic aneurysm after the operation indicated that the inflammatory polyp was caused by the aneurysm. These results suspect that we encountered a rare case of an inflammatory polyp in the course of aortoesophageal fistula formation.

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