We report on an arteriosclerotic aneurysm of the descending aorta penetrating into the esophagus. On endoscopy it mimicked a bleeding esophageal tumour. The typical clinical course of aortoesophageal fistulas (AEF) exhibits Chiari's triad of midthoracic pain, sentinel arterial hemorrhage, usually hematomesis, and final exsanguination after a symptom-free interval. The various causes of AEF are discussed together with the respective diagnostic and therapeutic problems.

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