Delayed Constrictive Pericarditis Following Presumed Esophagopericardial Communication After Esophageal Stenting

Figures

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  Figure 1. Anteroposterior chest radiograph showing bilateral pleural effusions (red arrows), more prominent on the left.

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  Figure 2. M-mode transthoracic echocardiography demonstrating septal bounce (abnormal early diastolic interventricular septal motion) (red arrows), consistent with constrictive physiology.

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  Figure 3. Subcostal M-mode transthoracic echocardiographic view demonstrating a dilated inferior vena cava with markedly reduced inspiratory collapse (arrows), consistent with elevated right atrial pressure.

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  Figure 4. Pulsed-wave Doppler of the transmitral inflow demonstrating marked respiratory variation in early diastolic (E-wave) velocity (arrows), consistent with constrictive physiology.

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  Figure 5. Axial contrast-enhanced computed tomography of the chest demonstrating multiple foci of air within the pericardial space (arrows), consistent with pneumopericardium, with associated bilateral pleural effusions.

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  Figure 6. Contrast-enhanced chest computed tomography (CT) with oral contrast demonstrating opacification of the esophageal lumen without evidence of contrast extravasation or a visible fistulous communication. A: Axial CT image demonstrating oral contrast within the esophageal lumen (green arrow). B: Coronal CT image demonstrating oral contrast within the esophageal lumen (red arrows) and the esophageal stent (yellow arrow). C: Axial CT image demonstrating oral contrast within the esophageal lumen (green arrow) and the esophageal stent (yellow arrows). No contrast extravasation or fistulous communication is identified. D: Axial CT image demonstrating persistent oral contrast within the esophageal lumen (green arrow).

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  Figure 7. Material derived from pericardial cavity

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  Figure 8. Trends of C-reactive protein (CRP) and white blood cells (WBCs) during hospital course

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  Figure 9. Postoperative chest radiography demonstrating almost complete resolution of the bilateral pleural effusions. Arrows show postoperative metal sutures.

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  Figure 10. Postoperative transthoracic echocardiography findings A: Apical four-chamber view demonstrating no significant pericardial effusion (arrows). B: Continuous-wave Doppler of the transmitral inflow showing no significant respiratory variation (arrows). C: Continuous-wave Doppler of the transtricuspid inflow demonstrating no significant respiratory variation (arrows).