Gastropericardial fistula causing cardiac tamponade

Case contributed by Khalid Alhusseiny


Epigastric pain following upper gastrointestinal (GI) endoscopy and biopsy for a gastric mass.

Patient Data

Age: 80 years
Gender: Male

There is a large pneumopericardium on the frontal radiograph of the chest.

Following swallowing of water soluble contrast media; a focal outpouching is seen at the gastric fundus with suspected faint contrast leak.

There is marked wall thickening (mass) of the gastric fundus where there is a focal defect connecting the stomach to the pericardium transdiaphragmatically with subsequent large pneumopericardium and extra-luminal contrast leak. Axial image shows a small heart with flattening of the anterior border, bilateral pleural effusions and basal pulmonary collapse.

Case Discussion

Gastropericardial fistula represents a rare abnormal communication between the stomach and the pericardial sac. Flattened cardiac contour and small heart size indicate cardiac tamponade, a life-threatening condition.

In this case; it was secondary to upper GI endoscopy and biopsy of gastric fundus mass.

Other causes can include esophageal or gastric surgery or tumor, gastric ulcer or trauma.

Image courtesy of Dr. Mai Tawfeek and Dr. Fatemah Zeinhoum.

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