Correspondence

Anatomy of a Diagnosis

N Engl J Med 2003; 349:2465December 18, 2003

Article

To the Editor:

Collard et al. describe the diagnosis and management of an aortopulmonary fistula in a patient with hemoptysis (Sept. 4 issue).1 The diagnosis was delayed for seven weeks while the patient underwent a battery of laboratory tests, multiple imaging studies, bronchoscopy, and even thoracoscopic lung biopsy, as well as empirical treatment with corticosteroids. The lesson is that hemoptysis in a patient with a history of thoracic aortic surgery should be considered the herald of an aortopulmonary fistula until proven otherwise. A recent review of this topic emphasized the importance of clinical suspicion, particularly when imaging studies are inconclusive.2

Robert D.B. Jaquiss, M.D.
Children's Hospital of Wisconsin, Milwaukee, WI 53226
rjaquiss@chw.org

2 References

1. 1

   Collard HR, Gruber MP, Weinberger SE, Saint S. Anatomy of a diagnosis. N Engl J Med 2003;349:987-992
   Full Text | Web of Science | Medline

2. 2

   Piciche M, De Paulis R, Fabbri A, Chiariello L. Postoperative aortic fistulas into the airways: etiology, pathogenesis, presentation, diagnosis, and management. Ann Thorac Surg 2003;75:1998-2006
   CrossRef | Web of Science | Medline

Author/Editor Response

We are in complete agreement with Dr. Jaquiss that the initial differential diagnosis in the case of our patient who presented with hemoptysis and a history of aortic-coarctation repair should have included aortobronchial fistula; this was one of our reasons for discussing the case.

Harold R. Collard, M.D.
University of Colorado Health Sciences Center, Denver, CO 80262
hal.collard@uchsc.edu

Steven E. Weinberger, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215

Sanjay Saint, M.D., M.P.H.
Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48105

Citing Articles (1)

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1. 1

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