CTICasesEsophagopericardial Fistula
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Imaging findings
Chest radiography shows air in the mediastinum confined to the pericardial space, without extension superiorly into the neck recesses. An oral contrast pericardiogram, performed using barium or water-soluble contrast, demonstrates contrast extravasating from the lower esophagus directly into the pericardial space, confirming the presence of a fistula.
Key takeaways
Pneumopericardium can be differentiated from pneumomediastinum on radiography by the confinement of air below the level of the great vessel pericardial reflections. An esophagopericardial fistula is a rare, life-threatening complication that can develop after chemoradiation for esophageal cancer, and can be diagnosed elegantly using oral contrast administration to document communication between the GI tract and the pericardium.
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