Diagnostic imaging for DeBakey type III aortic dissection complicated by aneurysm rupture with the formation of an aortoesophageal fistula: a case report

Aortic dissection is a type of acute aortic syndrome characterized by a high mortality rate in the first 48 hours. The problem of early diagnosis of acute aortic dissection is still relevant and due to a high risk of severe complications, as well as a non-specific clinical features. If left untreated, aortic dissection can be complicated by the formation of an aortic aneurysm and its rupture. Sometimes, the rupture of an aortic aneurysm is accompanied by the fistula formation. The article discusses the use of computed tomography (CT) scans for visualization of DeBakey type III aortic dissection complicated by aortic rupture and the formation of an aorto-esophageal fistula. A 60 y.o. male diagnosed with aortic dissection was urgently transferred from the city hospital for surgical treatment. As part of the preoperative preparation, the patient underwent computed tomography angiography (CT angiography), that demonstrated not only an acute DeBakey type III dissection with a thoracic aortic aneurysm of the descending aorta, but also its complication in the form of aortic rupture with the formation of aorto-esophageal fistula. The patient underwent a successful endovascular thoracic aortic stent grafting with unmarkable postoperative period. Follow-up CT angiography showed complete isolation of the false lumen and closure of the aorto-esophageal fistula. The patient showed clinical improvement and was discharged home on 14 day.