Pneumopericardium Secondary to Esophago‐Pericardial Fistula

Abstract

Mini‐Abstract We report the clinical case of a 63‐year‐old woman with a squamous cell carcinoma in the distal esophagus complicated by an esophago‐pericardial fistula and pneumopericardium. This is a rarely observed condition usually associated with a high mortality because may result in cardiac tamponade. However, as the esophago‐pericardial fistula was open and the air was free to enter and exit throughout the cardiac and respiratory cycle without significantly increasing pericardial pressure, our patient showed only a mild hemodynamic impairment without overt clinical signs of cardiac tamponade.

Elderly man with pneumonia

“…Esophagopericardial fistula carries a high mortality if there is a delay in diagnosis, and therefore, early treatment including pericardial drainage, broad‐spectrum antibiotics, and operative closure of the fistula is imperative. In the case of our patient, we believe that air and fluid was able to enter and exit throughout the respiratory and cardiac cycle (figure 4, videos 4 and 6) so that the patient did not develop clinical tamponade 2 . No causative role of esophageal stenting in development of esophagopericardial fistula has been identified 1 .…”

“…Esophagopericardial fisula is a rare disease and is most commonly associated with esophageal ulcers, foreign body impaction, post‐esophagogastroduodenoscopy perforation, breakdown of anastomotic sites, and malignancy 1,2 . Esophagopericardial fistula carries a high mortality if there is a delay in diagnosis, and therefore, early treatment including pericardial drainage, broad‐spectrum antibiotics, and operative closure of the fistula is imperative.…”

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

“…Patients with hemodynamic instability require emergent pericardiocentesis [1,2,5,7]. Watchful waiting may be considered if asymptomatic and hemodynamically stable, as it happened to our patient and with Caselli et al [3] and Durães-Campos et al [6], as it can resolve spontaneously or by treatment of the underlying condition [8].…”

“…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.…”

The way to a patient's heart is through their esophagus: A case of esophago‐pericardial fistula

“…Pneumopericardium is a rare condition in which air or gas exists in the pericardial space around the heart. Pneumopericardium can occur in many conditions, including trauma, resuscitation, esophageal cancer, lung disease, radiotherapy, and pericardiosyntesis 1–4 . Esophago‐pericardial fistula can occur after atrial fibrillation (AF) ablation, endoscopy, foreign body (fish bone), etc 5,6 .…”