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Cerebral arterial air emboli after stent insertion in esophageal cancer complicated with esophago‐left atrial fistula: An autopsy case and review of the literature
Author(s) -
Park Jong Kun,
Goto Takayoshi,
Nagano Teruaki,
Yoshimura Michiko,
Yutani Chikao
Publication year - 2019
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12849
Subject(s) - medicine , autopsy , dysphagia , esophagus , fistula , radiology , surgery , esophageal cancer , stent , complication , embolus , intracranial embolism , cancer , embolism
Cerebral arterial air embolism is a rare and unexpected complication of advanced esophageal cancer. The entry of air to systemic circulation is an esophago‐left atrial or pulmonary vein fistula formation. Herein, we report an autopsy case of a 64‐year‐old man. He was diagnosed esophageal cancer 2 years ago and underwent chemotherapy and concurrent chemoradiotherapy but the disease progressed, unfortunately. Then two metal stents were inserted into the middle thoracic esophagus as a palliation of dysphagia. After initiation of oral intake, he developed deterioration of consciousness. The cranial computed tomography showed cerebral arterial air emboli with multiple low‐density areas. He failed to gain consciousness again and died one and half days later. In a literature survey, this autopsy case is the first presentation that confirmed histologically the close association between stent placement and formation of esophago‐left atrial fistula. Due to the fatality of cerebral arterial air embolism, clinicians should keep in mind the possibility of this catastrophic complication after multimodality treatment of esophageal cancer.