Pericardioesophageal Fistula Following Left Atrial Ablation Procedure

Authors

  • Christopher William Bailey
  • Robert J Tallaksen

DOI:

https://doi.org/10.3941/jrcr.v8i10.1804

Keywords:

Left atrio-esophageal fistula, Pericardioesophageal fistula, CT angiography

Abstract

We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis.  After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest.  The study revealed pneumopericardium and a pericardial effusion.  Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus.  Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium.  Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect.  Endoscopic management was preferred and an esophageal stent was placed.  Follow up esophagram showed an intact esophageal stent without evidence of extravasation.

Author Biographies

Christopher William Bailey

Diagnostic Radiology Resident, PGY-3

Robert J Tallaksen

Professor of Radiology

Cardiopulmonary Imaging, Section Chief

Vice Chair of Education

Published

2014-10-19

Issue

Section

Cardiac Imaging