- 48 year old male with a
- history of GERD, SUD, and
- multiple episodes of esophageal perforations
- stenting 5 and 3 years prior
- complicated by
- esophagitis and
- esophageal stenosis s/p multiple dilations, most recently on
- presents with
- SOB, chest pain, nausea, and vomiting. 1 week following esophageal dilatation
- Tachycardic but afebrile
- WBC 19.7 and admission
- lactate of 2.8
- ECG showed diffuse ST elevation
- consistent with pericarditis.
- CT chest with IV contrast
- pneumopericardium with
- septations within the pericardial space and a
- thickened pericardial rind.
- chronic esophagopericardial fistula.
- ? due to recent instrumentation
- . Surgery
- sub xyphoid pericardial window and drainage
- for control of sepsis .
- findings
- purulence fluid a
- placed 10 flat JP drain within the pericardial sac
- Lab ID
- +Group B Strep (pericardial fluid/biopsy)
+Strep pneumoniae (blood, pericardial biopsy/fluid).
- +staph aureus
- Follow up gastrograffin
- no evidence of extravasation.
- . Interval cephalad migration of the esophageal stent,
- There is no evidence of leak or fistula on this exam.
