Aortoesophageal
fistula (
AEF) is an unusual cause of massive upper gastrointestinal
bleeding.
Thoracic aortic aneurysm is the most common etiology of primary
AEF followed by, respectively,
foreign body ingestion, esophageal
malignancy, and postsurgical fistulization. Radiation-induced damage to the great vessels is well recognized and some authors in the past have suggested that
AEF may be caused by
radiotherapy. However, previous case reports of radiation-induced
AEF involved patients who received
radiotherapy for esophageal
carcinoma, and precise histopathologic differentiation between
AEF secondary to esophageal
malignancy and that induced by radiation was difficult. We present here the unique case of a patient with a non-esophageal
carcinoma who received
radiotherapy before the development of an
AEF, thus providing further evidence for the role of
radiation injury in the development of this condition. As well, we discuss current opinion regarding etiology, clinical presentation, diagnosis, and management of this entity.