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Case Reports
. 2024 May 6;29(12):102357.
doi: 10.1016/j.jaccas.2024.102357. eCollection 2024 Jun 19.

Hydropneumopericardium Due to a Traumatic Esophageal-Pericardial Fistula

Usman Sagheer  1 , Sagar Bhandari  1 , Muhammad Umer  1 , Matthew Peters  1 , Matthew Shotwell  1 , Nanlong Liu  2 , Amor Royer  2 , Amrutha Mylarapu  3 , Dinesh K Kalra  1
Affiliations
Case Reports

Hydropneumopericardium Due to a Traumatic Esophageal-Pericardial Fistula

Usman Sagheer et al. JACC Case Rep. .

Abstract

Esophago-pericardial fistula is a rare, life-threatening condition, usually arising as a complication of benign esophageal disorders or iatrogenic causes. Prompt diagnosis via multimodality imaging is crucial, with computed tomography being the most sensitive. Management varies based on severity, with a growing trend toward early endoscopic interventions, which result in improved outcomes.

Keywords: esophageal perforation; esophago-pericardial fistula; hydropneumopericardium.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
12-Lead Electrocardiogram Sinus rhythm, low QRS voltage, and ST-segment elevations in lead II, III, aVF, and V3-V6 suggestive of pericarditis.
Figure 2
Figure 2
Transthoracic Echocardiography: Subcostal 4-Chamber View A moderate pericardial effusion (echolucency) is present (arrows).
Figure 3
Figure 3
Computed Tomography of the Chest Without Contrast (A) Axial, (B) coronal, and (C) sagittal views, showing pneumopericardium (white arrow), a complex pericardial effusion (asterisk), and pneumomediastinum (yellow arrow).
Figure 4
Figure 4
Series of Contrast Esophagrams: All in Anteroposterior Projection (A) Three weeks before hospitalization: proximal esophageal dilatation and distal narrowing (arrow) due to esophageal stricture, with no evidence of extraluminal contrast to suggest perforation. (B) Day 2 of hospitalization: esophageal mucosal irregularity with extravasation of contrast (arrow) suggestive of perforation. (C) Day 3 of hospitalization: esophageal stent in place (arrow) without evidence of contrast extravasation.
Figure 5
Figure 5
Series of Esophagogastroduodenoscopy Findings (Both Taken at the Same Level in the Lower Third of the Esophagus) (A) Three weeks before hospitalization showing a distal esophageal stricture (arrow). (B) Day 2 of hospitalization revealing severe esophagitis (arrowhead) and ulceration (asterisk) in the distal esophagus, likely the site of perforation.
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