Revision 8 for 'Atrial-esophageal fistula'

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Atrial-Esophageal Fistula

Atrial-Esophageal Fistulas are rare pathological connections between the left atrium and the esophagus. 

Clinical Presentation

Symptoms can include:

  • Fever
  • Neurological deficits 
  • Hematemesis 
  • Altered Mental Status
  • Chest Pain
  • Seizures
  • Nausea/Vomiting
  • Loss of Consciousness
  • Dysphagia
  • Abdominal Pain
  • Headache
  • Cough
  • Melena
  • Odynophagia
  • Dyspepsia

Pathology

The chief cause of atrial-esophageal fistulas in modern medicine is iatrogenic in ablation procedures of the heart. Although theoretically many mediastinal pathologies or procedures could also cause a fistula. 

Complications
  • Air embolism
  • Pneumomediastinum 
  • Pericardial effusion 
  • Infection 

Radiographic Features

Computed Tomography is the modality of choice to detect Atrial-Esophageal Fistulas. 

Chest CT will 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 induration
  • 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 fistulous area. Esophageal stenting can be used as a temporizing measure. 

The mortality is between 40-80%.

 

 

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