Abstract：
BACKGROUND: Purulent pericarditis secondary to esophago-pericardial fistula is a serious complication that has been previously reported in patients with esophageal cancer treated with radio/chemotherapy and esophageal stenting. However, the presence of esophago-pericardial fistula as the first manifestation of advanced carcinoma of the esophagus is exceedingly infrequent. We report the case of a 61-year-old male who presented with sepsis, cardiac tamponade and septic shock who was found to have an esophago-pericardial fistula secondary to squamous carcinoma of the esophagus. Emergency pericardiocentesis was performed with subsequent hemodynamic improvement. The drained pericardial fluid was purulent in nature and cultures were positive for Streptococcus anginosus. A CT scan followed by upper gastrointestinal endoscopy with tissue biopsy confirmed the diagnosis of squamous cell carcinoma of the esophagus. A self-expanding covered stent was endoscopically placed to exclude the fistula and restore the esophageal lumen. In this report, we discuss some aspects related to the diagnosis and management of this serious clinical entity.
摘要：
背景：继发于食道-心包瘘的化脓性心包炎是一种严重的并发症，以前曾在接受放化疗和食管支架置入治疗的食管癌患者中报道过。然而,食管-心包瘘作为晚期食管癌的首发表现极为罕见。我们报告了一个61岁的男性败血症的病例，心脏压塞和败血性休克，发现继发于食管鳞状细胞癌的食管-心包瘘。进行了紧急心包穿刺术，随后血流动力学得到改善。排出的心包液本质上是化脓性的，培养物对心绞痛链球菌呈阳性。CT扫描，然后上消化道内窥镜检查和组织活检证实了食管鳞状细胞癌的诊断。在内窥镜下放置自膨胀覆膜支架以排除瘘管并恢复食管腔。在这份报告中,我们讨论了与这个严重临床实体的诊断和管理有关的一些方面。
