Fatal bleeding following left internal jugular vein cannulation associated with type A1 endoleak, false aneurysm and aortobronchopulmonary fistula

This article reports the autopsy findings of a 76-year-old multimorbid man with polycystic kidney disease. A new replacement left internal jugular vein catheter had been inserted 2 months before death. The patient presented to hospital with nonspecific chest pain and a contained rupture of the descending thoracic aorta was verified by computed tomography (CT) angiography 1 week before death. The rupture was treated with thoracic endovascular aortic repair (TEVAR) and the patient was released from hospital in a stable condition with no sign of bleeding. Due to a permanent catheter malfunction the man was readmitted to hospital 7 days after the stent grafting. Within minutes after CT-assisted catheter replacement, the patient suffered hemoptysis. An emergency bronchoscopy did not identify the source of bleeding. The patient died within 1h following permanent catheter replacement due to massive hemoptysis. Internal examination revealed a penetrating atherosclerotic ulcer with a false aneurysm involving the descending thoracic aorta at the stent graft attachment site that had eroded into the adjacent lower lobe of the left lung. This article reports a case of fatal pulmonary hemorrhage manifesting as massive hemoptysis associated with an endoleak due to aortic stent graft displacement following venous cannulation. It is possible that a left internal jugular vein catheter insertion can be complicated with displacement of the aortic wall in some patients with a thoracic endoprosthesis.