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Effusive–constrictive pericarditis secondary to pneumopericardium associated with gastropericardial fistula
Author(s) -
Ono Yoshiyasu,
Hashimoto Toru,
Sakamoto Kazuo,
Matsushima Shouji,
Higo Taiki,
Sonoda Hiromichi,
Kimura Yasue,
Mori Masaki,
Shiose Akira,
Tsutsui Hiroyuki
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13135
Subject(s) - medicine , pneumopericardium , pericardiectomy , pericardium , pericardiocentesis , cardiac tamponade , surgery , mediastinitis , pericardial effusion , tamponade , pericarditis , fistula , constrictive pericarditis , radiology , complication
A 66‐year‐old man with a history of gastric pull‐up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X‐ray demonstrated pneumopericardium. Computed tomography revealed ulceration and abscess in the gastric conduit adjacent to the heart, suggesting gastropericardial fistula. As the patient did not show tamponade physiology, he was conservatively treated with antibiotics. The pneumopericardium diminished; however, he developed effusive–constrictive pericarditis with overt heart failure symptoms. Because pericardiocentesis failed to relieve the symptoms, pericardiectomy was performed. Intraoperative exploration revealed remarkably thickened pericardium and epicardium constituting multiple layers with purulent effusion. Epicardiectomy as well as pericardiectomy were required to achieve the effective reduction of central venous pressure. Perforation of the gastric conduit into the pericardial cavity was identified and repaired. Histopathology demonstrated thickened pericardium composed of hyalinized stroma, collagenous bundles, and infiltration of inflammatory cells. Streptococcus anginosus and Candida tropicalis were identified by culture of the resected tissue.

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