Atrio-esophageal fistula

Atrial-Esophageal Fistulas-oesophageal fistulas are rare pathological connections between the left atrium and the esophagusoesophagus. 

Clinical Presentation

Symptoms can include:

• Fever
• Neurological deficits 
• Hematemesis 
• Altered Mental Status
• Chest Pain
• Seizures
• Nausea/Vomiting
• LossThe presentation is non-specific and occurs 1-5 weeks after the procedure. Patients may complain of Consciousness
• Dysphagia
• Abdominal Pain
• Headache
• Cough
• Melena
• Odynophagia
• Dyspepsia

Pathology

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

Complications

• Airair embolism
• Pneumomediastinum pneumomediastinum
• Pericardialpericardial effusion
• Infectioninfection 

Radiographic Featuresfeatures

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

Chest CT will, and may reveal a communication between the left atrium and the esophagusoesophagus which can be evidenced by IV contrast present in the esophagus.

Other possible features include:

• Pericardialpericardial effusion
• Pneumomediastinumpneumomediastinum
• Gasgas within the chambers of the heart
• Posteriorposterior left atrial wall thickening
• Posteriorposterior mediastinal fat indurationstranding
• Narrownarrow irregular ulcerated pulmonary vein

Treatment and Prognosisprognosis

The treatment is surgical including resection and repair of the necrotic heart tissue and esophagealoesophageal resection of fistulous area. EsophagealOesophageal stenting can be used as a temporizing measure.

The mortality Mortality rate is betweenhigh at ~60% (range 40-80%).