CTICasesLeft Atrial-Esophageal Fistula post Ablation
Imaging findings
CT chest shows small pockets of gas in the fat plane between the esophagus and the posterior left atrium, with associated pneumocephalus on brain MRI. The patient recently underwent catheter ablation for atrial fibrillation and presented with multiple strokes.
Key takeaways
Atrioesophageal fistula is a rare but highly lethal complication of catheter ablation for atrial fibrillation. Thermal injury to the posterior left atrial wall adjacent to the esophagus leads to fistula formation, presenting with sepsis, gastrointestinal bleeding, or embolic strokes from air/food entry.
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