Atrio-esophageal fistula
Updates to Article Attributes
Atrial-oesophageal fistulas are rare pathological connections between the left atrium and the oesophagus.
Clinical presentation
The presentation is non-specific. Patients may complain of fever, malaise, dysphagia or present with neurological symptoms 3.
Pathology
The chief cause of atrial-oesophageal fistulas is iatrogenic in the setting of cardiac ablation procedures. Although theoretically many mediastinal pathologies or procedures could also cause a fistula.
Complications
Radiographic features
CT
CT is the modality of choice, and may reveal a communication between the left atrium and the oesophagus which can be evidenced by IV contrast present in the oesophagus.
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 oesophageal resection of fistulous area. Oesophageal stenting can be used as a temporizing measure. Mortality rate is high at ~60% (range 40-80%).
-<li><a title="Pericardial effusion" href="/articles/pericardial-effusion">pericardial effusion</a></li>-<li><a title="Pneumomediastinum" href="/articles/pneumomediastinum">pneumomediastinum</a></li>- +<li><a href="/articles/pericardial-effusion">pericardial effusion</a></li>
- +<li><a href="/articles/pneumomediastinum">pneumomediastinum</a></li>
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