An unusual case of massive hematemesis caused by aorto-esophageal fistula due to mycotic aneurysm of mid-thoracic aorta in a patient without prior aortic instrumentation.

In the words of Sir William Osler: "There is no disease more conducive to clinical humility than aneurysms of the aorta". Here, we describe a case of a primary fistulous tract between a pseudoaneurysm sac and a portion of the mid thoracic esophagus leading to massive extravasation of blood causing hemorrhagic shock in a 71-year-old female.