Summary
Introduction. Aortoesophageal fistula is a rare condition defined as an abnormal connection between the aorta and esophagus. Due to the risk of massive upper gastrointestinal bleeding, aortoesophageal fistula is life-threatening and has low survival rate. Although Chiari’s triad is considered a classic presentation, it appears in fewer than half of aortoesophageal fistula cases, and a definitive diagnosis is often made post-mortem.
Case report. A 65-year-old man who was found dead in his apartment. Multiple bloodstains were observed on the man’s face and floor near the body at the scene. The autopsy revealed aortic atherosclerosis, a dissecting aneurysm of the descending thoracic aorta, and a 3 cm vertical aortoesophageal fistula located 5 cm below the entry to the left subclavian artery. Blood clots (1100 g) with fibrin deposits were found in the stomach, indicating an earlier separate bleeding event.
Discussion and conclusions. Aortoesophageal fistula is a life-threatening condition. This case underscores the challenges of promptly diagnosing aortoesophageal fistula and highlights the vital role of autopsy in revealing the cause of death in such rare conditions. In clinical practice, monitoring and managing thoracic aortic aneurysms is essential for reducing the risk of developing the aortoesophageal fistula.
