Cough, Aortobronchial Fistula, and Air Migration in the Remnant Aneurysm Sac: An Unforeseen Path?

The pressure gap between the aortic lumen and bronchial air spaces makes hemoptysis the most frequent feature of aortobronchial fistula (ABF). However, air migration can be a rare cause of ABF. The literature has demonstrated some “indirect routes” that would serve as a bridge between ABF and consecutive air migrations. However, evidence suggesting the presence of a “direct route” between them is lacking. We present an extremely rare case of newly onset cough-induced “perigraft space ABF” and ABF-related air migration in the remnant aneurysm sac occurring 3 years after an aortic surgery and a near-misdiagnosis of a delayed graft infection.