Presentation
Patient with oesophageal carcinoma. Underwent radiation therapy, the last session was one month ago. Now presenting complaints of chest pain and shortness of breath.
Patient Data
There is wall thickening of the lower third of the oesophagus due to oedema with a disrupted anterior contour of the wall (perforation). In the delayed phase after the peroral administration of contrast medium, there is contrast leakage from the oesophagus lumen towards the pericardial cavity, consistent with an esophagopericardial fistula.
Massive pericardial effusion with air bubbles. There is an enhancement of the thickened pericardium.
Of note, there is inferior vena caval contrast reflux, nutmeg liver, and small bilateral pleural effusions.
Case Discussion
Radiation therapy is one of the treatment options for oesophageal carcinoma. Oesophageal perforation and fistulation are rare complications of radiation therapy. This case illustrates an RT-induced esophagopericardial fistula with a massive pericardial effusion (pericarditis).
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