Atrio-esophageal fistula

Case contributed by Kamil Abu-Shaban

Presentation

Abdominal pain and hematemesis one month post-radiofrequency ablation of the left atrium for atrial fibrillation.

Patient Data

Age: 65 years
Gender: Male
ct

Unusual outpouching of contrast along the posterior aspect of the left atrium directly adjacent to the esophageal lumen. 

ct

Development of extensive air scattered throughout the brain. This is likely air emboli secondary to an atrio-esophageal fistula. Poor grey-white matter differentiation and loss of sulci suggesting diffuse cerebral edema, ischemia, and/or infarction.

Case Discussion

This patient presented to the emergency department one month post-radiofrequency ablation for atrial fibrillation with a positive COVID-19 test and hematemesis. Chest x-ray was positive for bilateral infiltrates. GI was consulted for “COVID-19 GI Bleed” and an esophagogastroduodenoscopy (EGD) was performed to evaluate the hematemesis. The patient passed away from widespread air emboli in the brain. CT detected an atrio-esophageal fistula as a complication of the radiofrequency ablation. Widespread systemic air emboli were likely introduced through the fistula during EGD.

Case contributed by: Kamil Abu-Shaban, Xiaochen Liu MD & Bruce Siders DO.

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