Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy treated with a stent-graft

摘要

Diagnostic imaging in a 25-year-old female patient with a tracheoinnominate fistula. DSA of the brachiocephalic artery in posterior-anterior projection with an overinflated tracheal tube showed no bleeding source (a). Temporary removal of the tracheal tube and releasing the cuff revealed the contrast medium extravasation from the brachiocephalic artery’s posterior wall to the anterior wall of the adjacent trachea, with contrast medium in the trachea (arrow: bleeding spot; arrowhead: contrast medium in the trachea (b). The following completion flush DSA run of the aortic arch in a left anterior oblique projection showed the proper wall apposition of the stent-graft, the interruption of the previous extravasation, and the patency of the origins of the right subclavian and both common carotid arteries. The stent-graft was reaching slightly too far proximal into the aortic arch but did not compromise the origin of the left common carotid artery (c)