Pyopneumopericardium attributed to an esophagopericardial fistula: report of a survivor and review of the literature.
Herein we describe a case of pyopneumopericardium that resulted from formation of an acquired esophagopericardial fistula in a patient with silent, benign esophageal ulcer disease. Atypical features on initial examination suggested congestive heart failure or a pneumonic process (or both). The delayed development of pneumopericardium disclosed on a chest roentgenogram led to the clinical recognition of the esophagopericardial fistula. Subsequent emergent pericardiocentesis relieved cardiac tamponade and enabled us to diagnose pyopneumopericardium. A radiographic contrast study with use of meglumine diatrizoate revealed the site of the fistula in the midesophagus. The esophagopericardial fistula was surgically closed, and our patient had a good final result. Formation of an esophagopericardial fistula is a relatively uncommon finding; of the 60 previously reported cases, only 10 patients have survived. As illustrated in the current case, early diagnosis and treatment, including pericardial drainage and intense antibiotic therapy followed by a well-planned operative closure of the fistula, are paramount for the successful management of esophagopericardial fistulas.
Miller
W L
WL
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Osborn
M J
MJ
Sinak
L J
LJ
Westbrook
B M
BM
D000368:Aged; D001424:Bacterial Infections; D004937:Esophageal Fistula / Q000150:complications*; D005402:Fistula / Q000150:complications*; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology; D010493:Pericarditis / Q000209:etiology; D010496:Pericardium / Q000473:pathology; D011026:Pneumopericardium / Q000209:etiology*