Fig. 1

The pre-surgical examination: (a) Gastroscopic examination showed two esophageal fistulas approximately 0.2 cm and 0.3 cm in diameter respectively were found 23 cm away from the incisors; (b) Transverse, (c) three-dimensional volume-rendered and (d) sagittal computed tomography angiography demonstrated the pseudoaneurysm with a primary entry tear at the arch accompanied by gas-containing pleural effusion. *, irregular esophageal mural ulcers; LSA, left subclavian artery; LCCA, left common carotid artery; INA, innominate artery