Uncategorized
  • 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.