Atrio-esophageal fistula

Atrio-esophageal fistulas are rare pathological connections between the left atrium and the esophagus.

Clinical presentation

The presentation is non-specific. Patients may complain of fever, malaise, and/or dysphagia, or present with neurological symptoms .

Pathology

The chief cause of atrial-esophageal fistulas is iatrogenic in the setting of cardiac ablation procedures, although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.

Complications

• air embolism
• pneumomediastinum
• pericardial effusion
• infection 

Radiographic features

CT

CT is the modality of choice and may reveal a communication between the left atrium and the esophagus which can be evidenced by IV contrast present in the esophagus.

Other possible features include:

• pericardial effusion
• pneumomediastinum
• gas within the chambers of the heart
• posterior left atrial wall thickening
• posterior mediastinal fat stranding
• narrow irregular ulcerated pulmonary vein

Treatment and prognosis

The treatment is surgical, including resection and repair of the necrotic heart tissue and esophageal resection of the fistulous area. Esophageal stenting can be used as a temporizing measure. The mortality rate is high at ~60% (range 40-80%).

Siehe auch:

• ösophagoperikardiale Fistel