Atrio-esophageal fistula
Updates to Synonym Attributes
Updates to Synonym Attributes
Updates to Article Attributes
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Introduction
Epidemiology
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%.
-<h4>Introduction</h4><h4>Epidemiology</h4><h4>Clinical Presentation</h4><h4>Pathology</h4><h4>Radiographic Features</h4><h4>Treatment and Prognosis</h4><h4> </h4><p> </p>- +<p>Atrial-Esophageal Fistulas are rare pathological connections between the left atrium and the esophagus. </p><h4>Clinical Presentation</h4><p>Symptoms can include:</p><ul>
- +<li>Fever</li>
- +<li>Neurological deficits </li>
- +<li>Hematemesis </li>
- +<li>Altered Mental Status</li>
- +<li>Chest Pain</li>
- +<li>Seizures</li>
- +<li>Nausea/Vomiting</li>
- +<li>Loss of Consciousness</li>
- +<li>Dysphagia</li>
- +<li>Abdominal Pain</li>
- +<li>Headache</li>
- +<li>Cough</li>
- +<li>Melena</li>
- +<li>Odynophagia</li>
- +<li>Dyspepsia</li>
- +</ul><h4>Pathology</h4><p>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. </p><h5>Complications</h5><ul>
- +<li>Air embolism</li>
- +<li>Pneumomediastinum </li>
- +<li>Pericardial effusion </li>
- +<li>Infection </li>
- +</ul><h4>Radiographic Features</h4><p>Computed Tomography is the modality of choice to detect Atrial-Esophageal Fistulas. </p><p>Chest CT will reveal a communication between the left atrium and the esophagus which can be evidenced by IV contrast present in the esophagus.</p><p>Other possible features include:</p><ul>
- +<li>Pericardial effusion</li>
- +<li>Pneumomediastinum</li>
- +<li>Gas within the chambers of the heart</li>
- +<li>Posterior left atrial wall thickening</li>
- +<li>Posterior mediastinal fat induration</li>
- +<li>Narrow irregular ulcerated pulmonary vein</li>
- +</ul><h4>Treatment and Prognosis</h4><p>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. </p><p>The mortality is between 40-80%.</p><h4> </h4><p> </p>
References changed:
- 2. Shroff GS, Guirguis MS, Ferguson EC et-al. CT imaging of complications of catheter ablation for atrial fibrillation. Clin Radiol. 2014;69 (1): 96-102. <a href="http://dx.doi.org/10.1016/j.crad.2013.08.018">doi:10.1016/j.crad.2013.08.018</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24268510">Pubmed citation</a><span class="auto"></span>
- 1. Chavez P, Messerli FH, Casso Dominguez A et-al. Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports. Open Heart. 2015;2 (1): e000257. <a href="http://dx.doi.org/10.1136/openhrt-2015-000257">doi:10.1136/openhrt-2015-000257</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567782">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/26380098">Pubmed citation</a><span class="auto"></span>
Systems changed:
- Chest
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