Hemodynamically Significant Extrinsic Left Atrial Compression by Gastric Structures in the Mediastinum

Brief Communications15 July 1995Hemodynamically Significant Extrinsic Left Atrial Compression by Gastric Structures in the MediastinumSyed T. Raza, Sandip K. Mukherjee, Peter G. Danias, Jame Abraham, Kevin M. Johnson, Milton J. Sands, Morgan S. Werner, and David I. SilvermanSyed T. RazaFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Sandip K. MukherjeeFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Peter G. DaniasFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Jame AbrahamFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Kevin M. JohnsonFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Milton J. SandsFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., Morgan S. WernerFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut., and David I. SilvermanFrom the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-2-199507150-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Extrinsic left atrial compression is an uncommon source of hemodynamic compromise [1] that can be caused by many mediastinal structures, including bronchogenic cysts [2, 3], carcinoma [4], lymphoma [5], thymoma [6], aortic aneurysm [7], and diaphragmatic hernia [8]. To date, however, few cases of gastric structures (stomach, esophagus, or both) causing hemodynamically significant left atrial compression have been reported [9]. We describe three cases of extrinsic left atrial compression by the stomach that caused simultaneous hypotension and congestive heart failure.Case ReportsPatient 1A 60-year-old man with squamous cell carcinoma of the hypopharynx had elective transhiatal esophagectomy, which was complicated ...References1. D'Cruz IA, Feghali N, Gross CM. Echocardiographic manifestations of mediastinal masses compressing or encroaching on the heart. Echocardiography. 1994; 11:523-33. Google Scholar2. Maier HC. Bronchogenic cysts of the mediastinum. Ann Surg. 1948; 128:476-502. Google Scholar3. Volpi A, Cavalli A, Maggioni AP, Pieri-Nerli F. Left atrial compression by a mediastinal bronchogenic cyst presenting with paroxysmal atrial fibrillation. Thorax.1988; 43:216-7. Google Scholar4. DeLuca A, Daniels S, Pathak N. Pulmonary edema due to extreme left atrial compression. N J Med. 1991; 88:37-8. Google Scholar5. Iwase M, Nagura E, Miyahara T, Goto J, Kajita M, Yamada H. Malignant lymphoma compressing the heart and causing acute left-sided heart failure. Am Heart J. 1990; 119:968-70. Google Scholar6. Canedo M, Otken L, Stefadouras MA. Echocardiographic features of cardiac compression by a thymoma simulating cardiac tamponade and obstruction of the superior vena cava. Br Heart J. 1977; 39:1038-42. Google Scholar7. Breall JA, Goldberger AL, Warren SE, Diver DJ, Sellke FW. Posterior mediastinal masses: rare causes of cardiac compression. Am Heart J. 1992; 124:523-6. Google Scholar8. Nelson RM. Wilson RF, Huang CL, Jacobs LA, Steiger Z. Cardiac tamponade due to an iatrogenic pericardial-diaphragmatic hernia. Crit Care Med. 1985; 13:607. Google Scholar9. Baerman JM, Hogan L, Swiryn. Diaphragmatic hernia producing symptoms and signs of a left atrial mass. Am Heart J. 1988; 116:198-200. Google Scholar10. Alam M, Sun I. Transesophageal echocardiographic evaluation of left atrial mass lesions. J Am Soc Echocardiogr. 1991; 4:323-30. Google Scholar11. Movsowitz HD, Jacobs LE, Movsowitz C, Kotler MN. Transesophageal echocardiographic evaluation of a transthoracic echocardiographic pitfall: a diaphragmatic hernia mimicking a left atrial mass. J Am Soc Echocardiogr. 1993; 6:104-6. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the New Britain General Hospital, New Britain, Connecticut. The John Dempsey Hospital and University of Connecticut School of Medicine, Farmington, Connecticut. Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Connecticut.Corresponding Author: David I. Silverman, MD, Cardiology L3108, University of Connecticut Health Center, Farmington, CT 06030.Grant Support: In part by a Young Investigator Award from the Patrick and Catherine Weldon Donaghue Foundation (Dr. Silverman). 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