Author + information
- Received February 26, 2010
- Accepted March 8, 2010
- Published online March 22, 2011.
- Rachana Prasad, MA, BM, BCh,
- Mark Little, MB, BS,
- Sarojini David, MB, BS and
- Michael O'Sullivan, MA, MB, BChir, PhD
A 70-year-old man presented with chest pain and inferolateral ST-segment elevation on electrocardiogram via primary percutaneous coronary intervention service. He had gastric cancer, palliated with radiotherapy. Coronary angiogram showed unobstructed arteries and a radiolucent pericardial space with a craggy surface (A, Online Video 1). Echocardiography was hindered by trapped pericardial air. Subcostal views showed a pericardial effusion containing air bubbles, no tamponade, and thickening around the right atrium consistent with malignant infiltration (B, Online Video 2). Contrast-enhanced computed tomography (CT) showed hydropneumopericardium (C), produced by a fistulous tract between the gastric fundus and pericardial space (D). The opening of this fistula likely caused the acute onset of chest pain. Radiation therapy in the oncological patient is a predisposing factor for such fistula formation (1). The patient was treated palliatively and died the next day. This case highlights the value of CT in the investigation of pericardial disease.
- Received February 26, 2010.
- Accepted March 8, 2010.
- American College of Cardiology Foundation