Tracheo-arterial Fustula (TAF) in a 16 Year Old Female 3 Months after Tracheostomy

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Journal of Investigative Medicine





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Purpose of study The purpose of this is to increases the awareness of this rare condition and its occurrence months after tracheostomy. Fistula between trachea and the innominate artery is a life-threatening complication and typically occurs during the 1 st 3 weeks after tracheostomy. Methods used Chart review and review of literature. Summary of results We present a 16-year-old female who was admitted to PICU with diagnosis of seizures and altered mental status. She had a prolonged course that was complicated by status epilepticus and encephalopathy which was diagnosed as anti-NMDAR encephalitis. She remained encephalopathic throughout her stay. She eventually needed tracheostomy which was done 1 month after her admission. Approximately 5 months after her stay and 3 months after her tracheostomy, she was found to have fresh blood coming out of her tracheostomy upon coughing. Immediately oxygen support was provided. She continued to have coughing spells with more blood coming out of her tracheostomy and subsequently from her nose and mouth. She developed massive haemorrhage from her tracheostomy. A code was called. We inflated the cuff, as instructed by ENT, and continued providing positive pressure ventilation. The patient eventually went into cardiac arrest. During the resuscitation, her rhythm was consistent with asystole. Unfortunately she did not have any signs of life and was pronounced dead. An autopsy results were consistent with TAF. Pathology reports showed tracheo-innominate fistula (TIF) at the end of tracheostomy tube causing massive haemorrhage into the airay with evidence of blood aspiration. Conclusions TAF is a life-threatening condition with a survival of 14%. Mechanism of TIF formation is mucosal necrosis into the wall of the trachea resulting in fistulous communication with the innominate artery due to pressure exerted by the tracheostomy tube, abnormally high innominate artery and low tracheostomy. Diagnosis is dependent upon a high index of suspicion. When suspected immediate action should be taken to stop the bleeding as diagnostic modalities may lead to delay and death. Temporary manoeuvres like over inflating the cuff, pressure on the stoma to compress the sentinel bleeder may be performed while waiting for surgical repair.


Investigative Techniques | Medicine and Health Sciences



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