Fistulas between the aorta and tracheobronchial tree are rare fatal complications that occur in patients treated with external and endobronchial radiation for carcinomas of the upper and lower respiratory tract. The etiopathogenesis can be multifactorial. We report the case of a patient with irradiated tracheal carcinoma who died of massive hemoptysis 25 months after completing therapy. Autopsy revealed a fistula between the trachea and arch of the aorta. Multiple colonies of cocci and bacilli were demonstrated within the media at the site of rupture and were absent in other areas of the aorta. The development of an aortotracheal fistula in this patient was most probably related to infection in an area of tracheal and vascular wall previously damaged by exposure to high doses of radiation.