Pyopneumopericardium attributed to an esophagopericardial fistula: Report of a survivor and review of the literature

W. L. Miller, M. J. Osborn, L. J. Sinak, B. M. Westbrook

Research output: Contribution to journalArticle

40 Citations (Scopus)

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
StatePublished - 1991

Fingerprint

Fistula
Survivors
Pneumopericardium
Esophageal Diseases
Pericardiocentesis
Diatrizoate Meglumine
Cardiac Tamponade
Ulcer
Early Diagnosis
Drainage
Thorax
Heart Failure
Anti-Bacterial Agents
Lung
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Miller, W. L., Osborn, M. J., Sinak, L. J., & Westbrook, B. M. (1991). Pyopneumopericardium attributed to an esophagopericardial fistula: Report of a survivor and review of the literature. Mayo Clinic Proceedings, 66(10), 1041-1045.

Pyopneumopericardium attributed to an esophagopericardial fistula : Report of a survivor and review of the literature. / Miller, W. L.; Osborn, M. J.; Sinak, L. J.; Westbrook, B. M.

In: Mayo Clinic Proceedings, Vol. 66, No. 10, 1991, p. 1041-1045.

Research output: Contribution to journalArticle

Miller, WL, Osborn, MJ, Sinak, LJ & Westbrook, BM 1991, 'Pyopneumopericardium attributed to an esophagopericardial fistula: Report of a survivor and review of the literature', Mayo Clinic Proceedings, vol. 66, no. 10, pp. 1041-1045.
Miller, W. L. ; Osborn, M. J. ; Sinak, L. J. ; Westbrook, B. M. / Pyopneumopericardium attributed to an esophagopericardial fistula : Report of a survivor and review of the literature. In: Mayo Clinic Proceedings. 1991 ; Vol. 66, No. 10. pp. 1041-1045.
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