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Mind the fistula
  1. Dean Burns,
  2. Dhakshinamoorthy Vijayasankar
  1. Peterborough City Hospital, Peterborough, UK
  1. Correspondence to Dr D Burns, Peterborough City Hospital, Edith Cavell Campus, Peterborough PE3 9GZ,UK; deanburns{at}


Thoracic aortic dissection (TAD) with aorto-oesophageal fistula formation is an uncommon but fatal cause of haematemesis. A case is presented of a previously healthy 63-year-old man who presented to the emergency department with syncope and haematemesis. He had no history of heavy alcohol intake and was previously well. Bedside portable chest x ray revealed a widened mediastinum and, while awaiting a CT angiogram, he had a further large haematemesis which led to him undergoing resuscitation and rapid sequence intubation. CT angiography of his thoracic aorta revealed a large thoracic aortic aneurysm with dissection from the arch of the aorta down to the left iliac artery. The dissection had formed an aorto-oesophageal fistula in the proximal oesophagus. He was transferred to a tertiary referral centre for repair of the dissection and aorto-oesophageal fistula.

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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