title: Thick lung wedge resection for acute life-threatening massive hemoptysis due to aortobronchial fistula.
abstract: Massive hemoptysis from an aortobronchial fistula due to thoracic aortic dissection is an extremely rare symptom, but is a potentially life-threatening condition. We report a case of acute massive hemoptysis due to aortobronchial fistula that was successfully controlled by a simple and rapid thick wedge resection of the lung with hematoma by using the black cartilage stapler. A 65-year-old man was admitted to our hospital with acute massive hemoptysis. After tracheal intubation, chest computed tomography revealed hematoma in the left lung and ruptured aortic dissection from the distal arch to the descending aorta. He was diagnosed with aortobronchial fistula and underwent an emergency surgery on the same day. We performed posterolateral thoracotomy. A dissecting aortic aneurysm (diameter, ~80 mm) with adhesion of the left upper lobe and the superior segment of the lower lobe was found. The lung parenchyma expanded with the hematoma. We stapled the upper and lower lobes by using the black cartridge stapler along the aortopulmonary window. Massive hemoptysis disappeared, and the complete aortic dissection appeared. Aortic dissection with adherent lung was excised, and graft replacement of the distal arch and descending thoracic aorta was performed. Proximal lung wedge resection using black cartridge stapler is a simple and quick method to control massive hemoptysis from aortic dissection; hence, this procedure is an effective option to control massive hemoptysis due to aortobronchial fistula. This technique could rapidly stop massive hemoptysis and prevent dissection of the adherent lung tissue and intra-thoracic bleeding.
authors.affiliation: Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sakai
authors.affiliation: Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ozawa
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Matsuzaki
keywords: Aortobronchial fistula; aortic dissection; hemoptysis; wedge resection