Saporta Inbar, Chennamadhavuni Adithya, Dolan Michael J
Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin.
Department of Internal Medicine, Gundersen Medical Foundation, La Crosse, Wisconsin.
WMJ. 2017 Jun;116(2):84-86.
75-year-old woman was admitted with fever, chills, altered mentation, and right-sided weakness. A month earlier, she had undergone catheter radiofrequency ablation for treatment of chronic atrial fibrillation. A magnetic resonance imaging scan of her brain revealed septic emboli with multiple bilateral cerebral and cerebellar infarcts, as well as extensive bilateral leptomeningeal enhancement. Blood cultures were positive for Streptococcus mitis, Rothia mucilaginosa, Streptococcus pneumonia, and Candida albicans, which suggested a connection between gastrointestinal and cardiovascular systems. A chest computed tomography scan with contrast showed a curvilinear low attenuation structure communicating between the esophagus and the left pulmonary vein-an atrioesophageal fistula. Ten days after admission, the patient died from multiple cerebral septic emboli secondary to atrioesophageal fistula following radiofrequency ablation.
一名75岁女性因发热、寒战、精神状态改变及右侧肢体无力入院。一个月前,她接受了导管射频消融术治疗慢性心房颤动。脑部磁共振成像扫描显示有脓毒性栓子,伴有双侧大脑和小脑多处梗死,以及广泛的双侧软脑膜强化。血培养结果显示缓症链球菌、黏液罗氏菌、肺炎链球菌和白色念珠菌呈阳性,提示胃肠道和心血管系统之间存在联系。胸部增强计算机断层扫描显示食管与左肺静脉之间有一条曲线状低密度结构相通——即心房食管瘘。入院十天后,患者因射频消融术后继发心房食管瘘导致的多发性脑脓毒性栓子死亡。