Miller W L, Osborn M J, Sinak L J, Westbrook B M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1991 Oct;66(10):1041-5. doi: 10.1016/s0025-6196(12)61728-5.
Herein we describe a case of pyopneumopericardium that resulted from formation of an acquired esophagopericardial fistula in a patient with silent, benign esophageal ulcer disease. Atypical features on initial examination suggested congestive heart failure or a pneumonic process (or both). The delayed development of pneumopericardium disclosed on a chest roentgenogram led to the clinical recognition of the esophagopericardial fistula. Subsequent emergent pericardiocentesis relieved cardiac tamponade and enabled us to diagnose pyopneumopericardium. A radiographic contrast study with use of meglumine diatrizoate revealed the site of the fistula in the midesophagus. The esophagopericardial fistula was surgically closed, and our patient had a good final result. Formation of an esophagopericardial fistula is a relatively uncommon finding; of the 60 previously reported cases, only 10 patients have survived. As illustrated in the current case, early diagnosis and treatment, including pericardial drainage and intense antibiotic therapy followed by a well-planned operative closure of the fistula, are paramount for the successful management of esophagopericardial fistulas.
在此，我们描述了一例脓性心包积气病例，该病例由一名患有无症状良性食管溃疡疾病的患者出现后天性食管心包瘘所致。初次检查时的非典型特征提示充血性心力衰竭或肺部病变（或两者皆有）。胸部X线片显示的心包积气延迟出现促使临床认识到食管心包瘘。随后的紧急心包穿刺术缓解了心脏压塞，并使我们能够诊断脓性心包积气。使用泛影葡胺进行的造影检查显示瘘管位于食管中段。食管心包瘘通过手术闭合，我们的患者最终预后良好。食管心包瘘的形成是一种相对罕见的情况；在之前报道的60例病例中，仅有10例患者存活。如本例所示，早期诊断和治疗，包括心包引流和强化抗生素治疗，随后精心计划手术闭合瘘管，对于食管心包瘘的成功治疗至关重要。
