Tuberculous Aortitis as a Rare Cause of Aortobronchial Fistula With Massive Haemoptysis: A Case Report

Background: Aortobronchial fistula is a rare condition, which is difficult to diagnose. It is fatal if misdiagnosed or not well treated. Massive haemoptysis is usually the first common symptom. Computed tomography angiogram (CTA) is the best non-invasive diagnostic modality. Treatment options include open repair procedure or Transthoracic Endovascular Aortic Repair (TEVAR) and resection of the destroyed lung tissue. The recurrent rate is high.

Case presentation: This report is a case of a 26-year-old African female patient who presented with massive haemoptysis. She had been treated for pulmonary tuberculosis two years before. The patient was diagnosed with retroviral disease and had been on treatment for two years. She underwent a 2-stage repair procedure. The initial treatment was TEVAR, which was followed by lung resection after two weeks. Both operations were uneventful. Histopathology analysis confirmed tuberculous aortitis as aetiology. The patient had been followed up for a year, with no recurrence.

Discussion: Aortobronchial is divided into primary and secondary subtypes. Primary aortobronchial fistula is commonly caused by inflammatory disease and atherosclerosis. Secondary aortobronchial fistula is a complication of surgery for thoracic aorta and congenital cardiac disease. Tuberculous fistula is an uncommon cause of aortobronchial fistula. Surgery for aortobronchial fistula should include controlling both aortic and pulmonary fistula sites. A healthy tissue or muscle flap should be used between the repaired sites to prevent refistulisation. Recurrence is common; hence, long-term follow up is important.

Conclusion: Early diagnosis and adequate treatment are important. A high index of suspicion is important for diagnosis, because the diagnosis is difficult.