CTICasesAtrio-esophageal Fistula with Pneumopericardium Post-Left Atrial Ablation
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Imaging findings
Radiographs showed subsegmental opacities in the lower lung zones and an unusual collection of gas (pneumopericardium). CT confirmed pneumopericardium with fluid in the anterior pericardial space. The esophagus was distended with fluid and air. Air was also seen adjacent to the esophagus and left atrium, consistent with communication into the oblique sinus of the pericardial space.
Key takeaways
This is a dramatic presentation of an atrio-esophageal fistula, a severe complication of left atrial ablation for atrial fibrillation, leading to pneumopericardium. Surgical findings confirmed defects in both the esophagus and the posterior left atrium (near the left inferior pulmonary vein), which were surgically repaired. The case highlights the importance of prompt recognition of this potentially fatal complication, though this patient was fortunate not to experience air emboli to the brain.
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See all cases from September 24, 2015 →