Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

Aorta-cameral fistulas: Spectrum of CT findings and review

Aorto-cameral fistula (ACF) is an uncommon entity, defined as an abnormal communication between the aorta and a cardiac chamber. The most common causes include ruptured sinus of Valsalva aneurysm, infective endocarditis, traumatic injury, aortic dissection, or rarely can be iatrogenic in nature. While smaller communications may initially be asymptomatic, the natural course of these connections is generally refractory heart failure as they do not spontaneously heal. Larger fistulas can be life threatening with high mortality rates, and therefore once recognized, surgery is generally considered the treatment of choice. Diagnosis, however, can be challenging, and various imaging modalities are often used for diagnosis. This review highlights common underlying etiologies, clinical manifestations, and radiologic imaging appearances of ACF to each of the cardiac chambers of this uncommon, but clinically important entity, with emphasis on CT.

Acquired Thoracic Fistulas

Fistulas are abnormal connections between 2 epithelial-lined structures. Thoracic fistulas may result from nonanatomic communications between spaces within the thorax, such as the lung, tracheobronchial tree, pleural space, and mediastinal structures, or between thoracic spaces and extrathoracic structures, such as the gastrointestinal tract. Furthermore, thoracic fistulas may result in communication between thoracic spaces and the spine or vascular structures. Potential causes include trauma, infection, neoplasm, surgical intervention, or medical syndromes. In this article, we discuss various acquired thoracic fistulas and their potential causes, key multimodality imaging manifestations, and clinical significance.

Long-Term Traumatic and Asymptomatic Aorto-Right Atrial Fistula

Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.