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Case Reports
. 2022 Dec 16;14(12):e32608.
doi: 10.7759/cureus.32608. eCollection 2022 Dec.

Acute Pericarditis Hiding an Esophageal Perforation

Catarina Osório  1 , Lucia Carvalho  1 , Ana Marta Pereira  1 , Mário Nora  1 , Marta Guimarães  1
Affiliations
Case Reports

Acute Pericarditis Hiding an Esophageal Perforation

Catarina Osório et al. Cureus. .

Abstract

Esophageal perforations due to foreign body ingestion are uncommon; however, they can be associated with extremely high mortality rate. The most dreadful complication of this entity is the infection of adjacent structures, namely, the mediastinum and the pericardium. A prompt diagnosis and a precocious start of treatment are essential to the prognosis. Thus, a high degree of suspicion is required, especially in older patients. Therapeutic options are highly variable, depend on several factors, and should be individualized to every patient and their clinical status. Surgical treatment with esophageal exclusion and diversion, in extreme circumstances, is mandatory to control the infection source site and prevent further contamination. We report a case of esophageal perforation, presenting 48 hours after onset, that led to multifactorial shock (septic and cardiogenic) due to pericarditis with pericardial and pleural effusion.

Keywords: acute pericarditis; esophageal exclusion; esophageal perforation; foreign body ingestion; pneumomediastinum.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Contrast-enhanced thoracoabdominal CT
Axial (A) and coronal (B) sections of contrast-enhanced thoracoabdominal CT demonstrating pneumomediastinum (arrows) CT: computed tomography
Figure 2
Figure 2. Pre-esophageal infra-carinal collection
Contrast-enhanced thoracoabdominal CT showing a pre-esophageal infra-carinal collection with 4 mm maximum anteroposterior thickness and 50 mm in the largest transverse axis, containing liquid and gas bubbles (arrow) suggesting perforation of the esophagus CT: computed tomography
Figure 3
Figure 3. Imagiological signs of acute pericarditis
Contrast-enhanced thoracoabdominal CT highlighting a small- to moderate-volume pericardial effusion (red arrow) associated with enhanced pericardial thickening after contrast in favor of pericarditis (blue arrow) CT: computed tomography
Figure 4
Figure 4. Control CT
Control CT revealed the absence of pericardial effusion (arrow) and pneumomediastinum CT: computed tomography
See this image and copyright information in PMC

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