title: A case of aorto-bronchial fistula after insertion of left main bronchial self-expanding metallic stent in a patient with recurrent esophageal cancer.
abstract: We report a case of aorto-bronchial fistula (ABF) caused by a self expanding metallic stent (EMS) 51 days after insertion into the left main bronchus. The patient presented with left main bronchial stenosis caused by post-operative local recurrence of esophageal cancer. Post-operative radio therapy totaling 40 Gy and post-recurrence radiotherapy totaling 34 Gy were administered, with daily fractions of 2 Gy. Stenosis of the left main bronchus improved slightly, and was followed with insertion of EMS to prevent restenosis. The patient experienced massive hemoptysis for 3 days before sudden death. Autopsy revealed the EMS edge perforating the descending aortic lumen. Tumor infiltration and bacterial infection were observed on the wall of the left bronchus, and atherosclerosis was present on the aortic wall around the fistula. It should be noted that the left main bronchus was at considerable risk of ABF after insertion of EMS for malignant stenosis, and prophylactic sent insertion into the left bronchus without imperative need must be avoided.
authors.affiliation: Department of Radiation Oncology, Yamanashi Medical University, 1110 Shimokato Tamaho-cho Nakakoma-gun Yamanashi, 409-3898, Japan. honishi@res.yamanashi-med.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onishi
authors.forename: Kengo
authors.initials: K
authors.lastname: Kuriyama
authors.forename: Takafumi
authors.initials: T
authors.lastname: Komiyama
authors.forename: Shiho
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kan
authors.initials: K
authors.lastname: Marino
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Araki
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D001344:Autopsy; D001980:Bronchi; D001983:Bronchial Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D003287:Contrast Media; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016157:Vascular Fistula / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D003287:Contrast Media