TY - JOUR
T1 - Pyopneumopericardium Attributed to an Esophagopericardial Fistula
T2 - Report of a Survivor and Review of the Literature
AU - MILLER, WAYNE L.
AU - OSBORN, MICHAEL J.
AU - SINAK, LAWRENCE J.
AU - WESTBROOK, BENJAMIN M.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1991
Y1 - 1991
N2 - 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.
AB - 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.
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U2 - 10.1016/S0025-6196(12)61728-5
DO - 10.1016/S0025-6196(12)61728-5
M3 - Article
C2 - 1921487
AN - SCOPUS:0025938978
SN - 0025-6196
VL - 66
SP - 1041
EP - 1045
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 10
ER -