Pneumopericardium as a rare complication after esophagopericardial fistula

Abstract

Pneumopericardium is a rare clinical entity which is often complicated by trauma. Pneumoperdicardium resulting after esophagopericardial fistula is much rarer. We present a case of pneumopericardium as the complication of esophagopericardial fistula in a 53-year-old man. After undergoing radiotherapy for 26 times, the patient got a fever and an unspecified thoracic pain. Echocardiography showed the rectilinear echoes in the pericardium. Chest computed tomography revealed pneumopericardium, pericardial effusion, recurrence of lung cancer, and pneumonia in right lower and left lung.

Cancer-Related Pneumopericardium: A Case Report and Literature Review

“…Identifying the fistula can assist with the management. Two similar cases described by Liao et al [16] and Wang et al [8] presented with an esophageal-pericardial fistula identified by CT scan. Both were treated by placing a stent and then the pneumopericardium resolved.…”

“…Echo can assess left ventricular function and measure the degree of cardiac compromise. Key findings summarized by Liao et al [16] included the absence of an image when there is a large amount of air in the pericardium which blunts the image from the probe; an air gap sign where the image disappears when the heart contracts during systole; a swirling bubble sign where multiple echogenic spots are identified in pericardial sac; and rectilinear echoes where multiple bright echoes pile up to form a rectilinear line which corresponds to the air-fluid level [16]. Most importantly, echocardiography allows for guided pericardiocentesis.…”

“…Other treatment focused on the location of the fistula. Endoscopy played an important role, such as used in the case of esophageal cancer stent implantation to block of the esophageal pericardial fistula [16]. It was important to watch for the development or presence of cardiac tamponade, in which case an urgent pericardiocentesis or pericardial window is warranted [6,8,[10][11][12].…”

The “Airgap” and “Swirling Bubbles” signs in a Patient with Esophageal Carcinoma

“…Comparing with current literature [1][2][3][4][5][6], cases of pneumopericardium have variable prognosis. In the setting of an esophago-pericardial fistula, it may resolve with therapy directed to the condition responsible for the fistula formation and scarring by second intention, but it is still a dreaded situation.…”

Complicated Iatrogenic Pneumopericardium in a Patient With Suspected Multiple Myeloma

“…If a chest X-ray includes air that envelops the aortic arch and superior vena cava above the azygous vein or distal left pulmonary artery, this is indicative of air outside the limits of the pericardium. [ 4 ] Some cases may require chest CT to evaluate pneumopericardium size and to rule out causes like fistulous communications between the esophagus or lungs as well as proof of other injuries that may lead to this rare complication [ 8 , 10 , 11 ]. In addition, echocardiographic findings that may suggest a pneumopericardium include an air gap sign where the image disappears when the heart contracts during systole (Supplemental Video 3 ), absence of an image (Supplemental Video 4 ), or a swirling bubble sign where multiple bright echoes pile up to form a rectilinear line which corresponds to the air-fluid level (Supplemental Video 5 ) [ 6 , 12 ].…”