Cardiac tamponade related oesophageal perforation

A 70 years old patient consulted for acute chest pain spreading to the back. First clinical examination, electrocardiogram and echocardiography were consistent with the diagnosis of pericarditis with pericardial effusion. A computed tomography (CT) scan was performed to ruled out an acute aortic dissection, showing a pericardial effusion (Panel A: black stars), pneumopericardium (Panel B: arrow) and a thick pericardium (Panel A, arrow) with a thin linear oesophageal foreign body [arrowhead on Panels A–C (3D volume rendering)]. Because of symptom worsening with sign of acute tamponade, surgical drainage of the pericardium was performed, revealing a purulent effusion associated with small fragment of rice leading to us to suspect an oesophageal fistula. A second CT scan with upper digestive opacification (Panel D, arrow) showing less pericardial effusion following surgical drainage (Panel E, arrow—drain, circles) and a pericardial-oesophageal fistula with passage of the contrast from the oesophagus to the pericardium (Panels D–F arrowheads. D and F are thin maximum intensity projection). The fistula was surgically closed (Panel G: oesophagus, right arrowhead and pericardium, left arrowhead—and Supplementary data online, Video S1) and the foreign body removed which was finally a chicken bone fragment (Panel H). Additionally, broad-spectrum antimicrobial therapy was initiated. The patient was discharged from intensive care unit few days after. Supplementary data are available at European Heart Journal online. All authors declare no conflict of interest for this contribution. No data were generated or analysed for or in support of this paper.