CTICasesEsophagopericardial Fistula from Esophagitis
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Imaging findings
A lateral chest radiograph reveals air in the pericardial space, outlining the right ventricular outflow tract, indicating pneumopericardium. A CT scan confirms anterior pneumopericardium and demonstrates a fistula connecting the esophagus to the pericardial space. A swallow study further confirms active leakage of oral contrast into the pericardium. The patient has a history of alcohol and heroin use with repeated bouts of esophagitis.
Key takeaways
An esophagopericardial fistula, a direct communication between the esophagus and the pericardial space, is a severe complication of esophageal perforation. While often associated with cancer or radiation, this case demonstrates its occurrence secondary to severe esophagitis. Pneumopericardium is a key imaging sign, and a swallow study with oral contrast is diagnostic for confirming the fistula and active leakage.
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