Gastropericardial fistula

Case contributed by Dr Khalid Alhusseiny

Presentation

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

Patient Data

Age: 80 years
Gender: Male
X-ray

There is moderate amount of 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.

CT

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 moderate pneumopericardium and extra-luminal contrast leak.

Case Discussion

Gastropericardial fistula represents a rare abnormal communication between the stomach and the pericardial sac. This condition can be life-threatening if associated with impaired cardiac function.

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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