Oesophageal–pericardial and atrio-oesophageal fistula complicating a pulmonary vein isolation procedure

Figures

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  Fig. 1. Thoracic–abdominal–pelvic CT scan. (A) Portal venous phase CT scan: Presence of pericardial thickening and hydroaeric pericardial effusion (arrowheads). (B) After upper-route opacification using a 1:10 diluted oral water-soluble contrast medium administered prior to an additional scan, discontinuity of the anterior oesophageal wall with contrast leakage and stagnation of ingested contrast medium in the posterior portion of the cardiac mass (arrow) is seen, suggestive of an atrio-oesophageal fistula through the pericardium. (C) Hydroaeric level with contrast medium stagnation in the pericardium (arrow). (D) Coronal oblique reconstructions with maximum intensity projection showing contrast leakage (arrowheads). (E) Axial oblique reconstructions with maximum intensity projection showing contrast leakage (arrowheads).

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  Fig. 2. Endoscopic management. (A) Endoscopic view of fistulous orifice. (B) Covered oesophageal prosthesis under fluoroscopic guidance.

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  Fig. 3. Cerebral perfusion CT. Increased TTP (time to peak) and decreased CBV (cerebral blood volume) within the territory of the right middle cerebral artery and the right anterior cerebral artery (arrowheads).

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  Fig. 4. Cerebral and thoracic CT scan after altered neurological state. (A) Intraparenchymal supratentorial air embolism (arrows). (B) Presence of air bubbles in the left ventricle (arrowheads).

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  Fig. 5. Brain apparent diffusion coefficient (ADC) map (diffusion-weighted MRI) decreased right frontotemporal-parietal ADC (arrowheads).