Aortoesophageal fistula (AEF) is a rare but fatal cause of gastrointestinal hemorrhage, being most commonly associated with thoracic aortic aneurysm. We present a rare case of secondary AEF post graft treatment for mycotic aneurysm of thoracic aorta 4 years previously. Massive upper gastrointestinal hemorrhage resulted in difficult diagnosis by gastrointestinal endoscopy. Computed tomography angiography (CTA) showed contrast extravasation from the descending aorta into the mid-third esophagus. CTA is a useful diagnostic tool in patients suspected of having AEF. Rapid identification of AEF is important for definitive treatment and increases the likelihood of survival.
