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PNEUMOPERICARDIUM: A RARE PRESENTATION OF GASTRO-PERICARDIAL FISTULA
2151 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making PNEUMOPERICARDIUM: A RARE PRESENTATION OF GASTRO-PERICARDIAL FISTULA Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1129-374 Authors: Sohaib Tariq, Anoshia Raza, Srikanth Yandrapalli, Roshni Narurkar, Ali Ahmed, Wilbert Aronow, Alan Gass, Howard Cooper, Westchester Medical Center/New York Medical College, Valhalla, NY, USA, VA Medical Center, Washington, DC, USA Background: Pneumopericardium is a rare condition with a high mortality
Case: An 83-year-old man with chronic kidney disease presented with worsening epigastric pain for 2 months. Esophagogastroduodenoscopy (EGD) demonstrated an 8 cm benign-appearing ulcer within a hiatal hernia. Subsequent chest radiography revealed a large pneumopericardium (Fig 1A). Computed tomography with oral contrast demonstrated the presence of contrast within the pericardial cavity, confirming the presence of either esophago-pericardial or gastro-pericardial fistula (Fig 1B). Partial effacement of the right ventricle raised concern for tension pneumopericardium. The patient subsequently became hemodynamically unstable with worsening renal failure, and elevated liver enzymes Decision‐Making: Pneumopericardium was felt to be a result of either pericardial perforation by a large hiatal hernia ulcer or instrumental esophageal perforation during the EGD. As conservative management of this condition is associated with a high mortality rate, surgical intervention was recommended. Exploration of the pericardial cavity via left thoracotomy revealed a large amount of air. Intra-operative EGD showed a hiatal hernia ulcer perforating into the pericardium. A pericardial window was performed with closure of the gastropericardial fistula. The patient improved hemodynamically. Conclusions: Gastro-pericardial fistula resulting in pneumopericardium is a rare condition which requires urgent surgical intervention
FIT Clinical Decision Making PNEUMOPERICARDIUM: A RARE PRESENTATION OF GASTRO-PERICARDIAL FISTULA Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1129-374 Authors: Sohaib Tariq, Anoshia Raza, Srikanth Yandrapalli, Roshni Narurkar, Ali Ahmed, Wilbert Aronow, Alan Gass, Howard Cooper, Westchester Medical Center/New York Medical College, Valhalla, NY, USA, VA Medical Center, Washington, DC, USA Background: Pneumopericardium is a rare condition with a high mortality
Case: An 83-year-old man with chronic kidney disease presented with worsening epigastric pain for 2 months. Esophagogastroduodenoscopy (EGD) demonstrated an 8 cm benign-appearing ulcer within a hiatal hernia. Subsequent chest radiography revealed a large pneumopericardium (Fig 1A). Computed tomography with oral contrast demonstrated the presence of contrast within the pericardial cavity, confirming the presence of either esophago-pericardial or gastro-pericardial fistula (Fig 1B). Partial effacement of the right ventricle raised concern for tension pneumopericardium. The patient subsequently became hemodynamically unstable with worsening renal failure, and elevated liver enzymes Decision‐Making: Pneumopericardium was felt to be a result of either pericardial perforation by a large hiatal hernia ulcer or instrumental esophageal perforation during the EGD. As conservative management of this condition is associated with a high mortality rate, surgical intervention was recommended. Exploration of the pericardial cavity via left thoracotomy revealed a large amount of air. Intra-operative EGD showed a hiatal hernia ulcer perforating into the pericardium. A pericardial window was performed with closure of the gastropericardial fistula. The patient improved hemodynamically. Conclusions: Gastro-pericardial fistula resulting in pneumopericardium is a rare condition which requires urgent surgical intervention