CTICasesAtrioesophageal Fistula
Imaging findings
CT chest with contrast in a patient post-Maze/radiofrequency ablation for atrial fibrillation shows subtle gas bubbles within the posterior left atrial wall and adjacent esophagus, associated with a small pneumomediastinum. Brain CT confirms cerebral arterial gas embolization (strokes).
Key takeaways
Atrioesophageal fistula (AEF) is a rare but highly lethal complication of catheter or surgical radiofrequency ablation of the left atrium. Direct thermal injury to the anterior esophageal wall leads to fistula formation. Presenting features include fever, sepsis, and neurological deficits from direct entry of esophageal gas/debris into the systemic arterial circulation.
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