Thoracic Aortic Erosion into the Esophagus With Aortoesophageal Fistula

Abstract

A 76-year-old woman with a past medical history of a known 6-cm thoracic aortic aneurysm was transferred to our facility for 1 day of hematemesis and hematochezia to undergo upper endoscopy. On arrival the patient had an emergent esophagogastroduodenoscopy, which revealed a visible thoracic aorta eroding into the esophagus through a large transmural defect (Figure A) and a nonbleeding aortoesophageal fistula (Figure B) directly superior to the erosion in the middle third of the esophagus. The patient underwent emergent computed tomography angiography of the aorta and a thoracic endovascular aorta repair with fluoroscopic images demonstrating extravasation at aortoesophageal fistula (Figure C, red arrow) and successful graft deployment and fistula closure (Figure D).