Key words
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Pneiimopcric:nrdiurn
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Esophngopcri-
cardial fistula - Cardiac tamponado
Schlüsselwörter --
i
I
-
Pneumopcrihiird - Esopliago-perikardiale Fistcl
I n tlie past deciitlr ilicirc?hns bccn an incrcasing iiitcrc~st iii piiei~iiiopcricarcliuin. its aetiology aiid irentinnrit ( 1 . 2. 3). I n thc following cire prest!nl a l i r i r ol' siniplc radiological investigalioiis revenling pncumopericardium. the fistula cniisiiig thc air Icak. cardiac tüiriponnde. I'rncturcs of scvcral ribs aiid piieiiriiolhorax in thc scquence it was preseiite(l h~ us b) oiic paticnt.
57-ycar old male witti a long history of'alcoholic abuse and sevrral bnlloon dilations of a benign oesopliagus sl.ricturc distally. on peptic basis. Oiic yenr prior to adrnittance. a distal oesopliagus tanr was succcssfully suturerl. Tlie pntient was admittcd to hospital wittr chest pnin. dyspnoca and weak coridilioii after a hlunt chcst trauma. Chest x-rays r ~ v e n l c dfracturcs of the 8Ih to 12'" ribs on the right sidc. and pneurnopericardium (Fig. 1). Thc ocsophagus was investignted with watcr-soluble contrast iriedia. dernonstrating a fistula froni tlie oesophagus to thc pericardiurn (Fig. 2). At. ttiis point also a Icft-sided narrow pneurnnthornx was shown. Later the cardiac volurne incrcascd on the chest X-ray as the pntient dcvcloped a cardiac iaiiipoiinde. Pcricardiotorny was periorrried eiiiptying 800 rnl rcd-greyish fliiid roiiowed by n tcmporary clinical irnproveinent. Thc paticnt cventually died in iriassive hnemorrhagc frorn the oesopliagus. The autopsy did not add any facts lo I h r clinical picturc.
Discussion ~-
Accurniilalion 01' nir frorn an ocsophagopericardial fistiiln into thc pcricardial sac is rare biit ol'ten fatal ifthc condition Progresses to cnrdiac tamponade.
Fortschr. Höntgenstr. 153.3(1990) 341 -342
0 GeorgTIiiernc VcrlagStuttgart . New York
Fig. 1 Pneurnopericardiumcircumscribingthe heari.
'l'he aetioiogy is orten benign oesophagcai disorders iricliiding gnstro-ocsophagcal reflux and peptic erosion. Onr third of the cases knowii arp on traurnatic basis (1)and this could Iinve been mislcading, since as oiir patient siin'ered frorn a trauma of the thoracic wall just prior to adrnittance resulting iri niiiltiple fractiired ribs.
Korzttinen ct al. ( I ) states that oesophagoscopy is rnandatory. This rnay be. hiit this invcstigation was pcrforrned on nur paticnt shortly after adrnittarice revealiiig orily diffuse irritatcd aiid swollen mucosa and no fistula. I n our case the patient did iioi. survive becnusc of poor general physical Status. dcspitc adequate treatrnent. 'l'liis is no surprising kiiowing that only 17 % have survivnd. according to litcraturc (1). Nevertheless, we woiild like to erripliasizc: thc iiripor[aiice of simplc radiological invcstigations i n order to reacti a sufiicient and quick tliagriosis.
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
Oesophagopericardial fistula resulting in pneumopericardium
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Heferences ~
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'
Konttinen. iid. I'., et al.: Esophagopericardial listula. A cilsc rrport aiid raview of the litci-aturc. Thorac. caidiovasc. Surg. 33 (1985) 341 -343 CUrnn,in,qs, H. G., et 01.: Pricurnopericardiurn resultir~gi r i cardiac Lniiipoiiadc. Thc .\nnnls o i Tlioracic Surg. 37/6 (1084) 511-517 Boriser, H. S.. E. G. Breuiirz: I'yopneumoparicardi~irn- 1i cornplicntion ol'gastro-csophagcal surgciy. Thc Uritish .lournal of(:linical Praclice 4 1 /9 ( 1987) 931 -932
Arne Seerup Heirndalsgade 45F DK-9000 Aalborg
Fig. 2 Watersoluble contrast media in esophagus and demonstrationof the fistula locatedanteriorly.
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- - - .-- .
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Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
-
,42 Fortschr. Hönlgenstr. 153.3
~
Pneiimopcric:nrdiurn
-
Esophngopcri-
cardial fistula - Cardiac tamponado
Schlüsselwörter --
i
I
-
Pneumopcrihiird - Esopliago-perikardiale Fistcl
I n tlie past deciitlr ilicirc?hns bccn an incrcasing iiitcrc~st iii piiei~iiiopcricarcliuin. its aetiology aiid irentinnrit ( 1 . 2. 3). I n thc following cire prest!nl a l i r i r ol' siniplc radiological investigalioiis revenling pncumopericardium. the fistula cniisiiig thc air Icak. cardiac tüiriponnde. I'rncturcs of scvcral ribs aiid piieiiriiolhorax in thc scquence it was preseiite(l h~ us b) oiic paticnt.
57-ycar old male witti a long history of'alcoholic abuse and sevrral bnlloon dilations of a benign oesopliagus sl.ricturc distally. on peptic basis. Oiic yenr prior to adrnittance. a distal oesopliagus tanr was succcssfully suturerl. Tlie pntient was admittcd to hospital wittr chest pnin. dyspnoca and weak coridilioii after a hlunt chcst trauma. Chest x-rays r ~ v e n l c dfracturcs of the 8Ih to 12'" ribs on the right sidc. and pneurnopericardium (Fig. 1). Thc ocsophagus was investignted with watcr-soluble contrast iriedia. dernonstrating a fistula froni tlie oesophagus to thc pericardiurn (Fig. 2). At. ttiis point also a Icft-sided narrow pneurnnthornx was shown. Later the cardiac volurne incrcascd on the chest X-ray as the pntient dcvcloped a cardiac iaiiipoiinde. Pcricardiotorny was periorrried eiiiptying 800 rnl rcd-greyish fliiid roiiowed by n tcmporary clinical irnproveinent. Thc paticnt cventually died in iriassive hnemorrhagc frorn the oesopliagus. The autopsy did not add any facts lo I h r clinical picturc.
Discussion ~-
Accurniilalion 01' nir frorn an ocsophagopericardial fistiiln into thc pcricardial sac is rare biit ol'ten fatal ifthc condition Progresses to cnrdiac tamponade.
Fortschr. Höntgenstr. 153.3(1990) 341 -342
0 GeorgTIiiernc VcrlagStuttgart . New York
Fig. 1 Pneurnopericardiumcircumscribingthe heari.
'l'he aetioiogy is orten benign oesophagcai disorders iricliiding gnstro-ocsophagcal reflux and peptic erosion. Onr third of the cases knowii arp on traurnatic basis (1)and this could Iinve been mislcading, since as oiir patient siin'ered frorn a trauma of the thoracic wall just prior to adrnittance resulting iri niiiltiple fractiired ribs.
Korzttinen ct al. ( I ) states that oesophagoscopy is rnandatory. This rnay be. hiit this invcstigation was pcrforrned on nur paticnt shortly after adrnittarice revealiiig orily diffuse irritatcd aiid swollen mucosa and no fistula. I n our case the patient did iioi. survive becnusc of poor general physical Status. dcspitc adequate treatrnent. 'l'liis is no surprising kiiowing that only 17 % have survivnd. according to litcraturc (1). Nevertheless, we woiild like to erripliasizc: thc iiripor[aiice of simplc radiological invcstigations i n order to reacti a sufiicient and quick tliagriosis.
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
Oesophagopericardial fistula resulting in pneumopericardium
--
- -
--
Heferences ~
'
'
Konttinen. iid. I'., et al.: Esophagopericardial listula. A cilsc rrport aiid raview of the litci-aturc. Thorac. caidiovasc. Surg. 33 (1985) 341 -343 CUrnn,in,qs, H. G., et 01.: Pricurnopericardiurn resultir~gi r i cardiac Lniiipoiiadc. Thc .\nnnls o i Tlioracic Surg. 37/6 (1084) 511-517 Boriser, H. S.. E. G. Breuiirz: I'yopneumoparicardi~irn- 1i cornplicntion ol'gastro-csophagcal surgciy. Thc Uritish .lournal of(:linical Praclice 4 1 /9 ( 1987) 931 -932
Arne Seerup Heirndalsgade 45F DK-9000 Aalborg
Fig. 2 Watersoluble contrast media in esophagus and demonstrationof the fistula locatedanteriorly.
P -
- - - .-- .
-
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
-
,42 Fortschr. Hönlgenstr. 153.3
