Aortopulmonary fistula caused by penetrating atherosclerotic ulcer and intramural hematoma

A 75-year-old woman presented with chronic cough and hemoptysis. Chest computed tomography (CT) and aortography revealed a small, contrast-filled outpouching in the wall of the descending aorta, which was thought to be the source of bleeding. At thoracotomy, there were firm adhesions between the descending aorta and the left S6. The aorta was clamped and the adhesions were removed revealing a defect in the aortic wall with thrombus. The defect was sutured. A penetrating atherosclerotic ulcer and intramural hematoma were diagnosed based on the radiological and operative findings.