Pyopneumopericardium Attributed to an Esophagopericardial Fistula: Report of a Survivor and Review of the Literature

WAYNE L. MILLER, MICHAEL J. OSBORN, LAWRENCE J. SINAK, BENJAMIN M. WESTBROOK

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1041-1045
Number of pages5
JournalMayo Clinic proceedings
Volume66
Issue number10
DOIs
StatePublished - Jan 1 1991

ASJC Scopus subject areas

  • Medicine(all)

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