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Imaging review of aortic fistulas
Journal article   Open access   Peer reviewed

Imaging review of aortic fistulas

Divij Agarwal, Christine O Menias, Mahan Mathur, Sumit Dhital, Archana Laroia, Hardik U Shah and Yashant Aswani
Abdominal radiology (New York)
05/09/2026
DOI: 10.1007/s00261-026-05544-8
PMID: 42105096
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1007/s00261-026-05544-8View
Published (Version of record) Open Access

Abstract

Aortic fistulas represent rare but life-threatening communications between the aorta and the adjacent structures, most commonly the gastrointestinal tract. They are classified as primary, arising spontaneously in the setting of a native, diseased aorta, or secondary to prior aortic surgery or endovascular repair. Clinical presentation is often variable and nonspecific-ranging from gastrointestinal bleeding, sepsis, abdominal pain to hemodynamic collapse-making imaging pivotal for diagnosis. Computed tomography angiography is the preferred imaging modality. Imaging features such as visualization of the fistula tract and active contrast extravasation into the fistulized hollow organ are definitive signs of aortic fistulas, but are rarely encountered. On the contrary, nonspecific indirect imaging features such as loss of fat planes and/or ectopic foci of gas are more frequently seen. Prompt recognition of these indirect imaging features is crucial, as delayed diagnosis significantly increases mortality. This review article summarizes the types, clinical features, and imaging findings of aortic fistulas, emphasizing the radiologist's pivotal role in timely detection and management of aortic fistulas.
 Aortopulmonary fistula Aortocaval fistula Endovascular aortic repair Aortoesophageal fistula Atherosclerosis Aortoenteric fistula Aortoatrial fistula Aortic aneurysm Aortobronchial fistula UIOWA OA Agreement

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