From oesophageal cancer to constrictive pericarditis: oesophagopericardial fistula complicated by Streptococcus equi infection—a case report

Figures

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  Figure 1. Electrocardiogram. Electrocardiogram at presentation showing sinus tachycardia (139 beats/min), subtle diffuse concave ST-segment elevation, and PR-segment depression, suggestive of pericardial involvement.

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  Figure 2. Contrast-enhanced computed tomography. There are small foci of extraluminal air (arrows) adjacent to the oesophagus and pericardium, with loss of normal fat planes, suggestive of an oesophagopericardial fistula. A moderate pericardial effusion is also present.

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  Figure 3. Purulent pericardial fluid. Thick, yellow turbid fluid obtained during pericardiocentesis, consistent with purulent pericarditis. Microbiological analysis identified Streptococcus equi.

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  Figure 4. Endoscopic images before and after oesophageal stent placement. (A) Endoscopic appearance of the oesophageal lesion before intervention. (B) Endoscopic appearance following placement of the partially covered self-expanding metallic stent.

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  Figure 5. Transthoracic echocardiography. (A) M-mode imaging suggesting septal bounce. (B) Tissue Doppler imaging of the septal mitral annulus demonstrating preserved e′ velocity. (C) Tissue Doppler imaging of the lateral mitral annulus showing reduced e′ velocity. The combination of preserved septal and reduced lateral e′ velocities (annulus reversus) is supportive of constrictive physiology.