Hospital: Hospital ramón y Cajal., Hospital Ramón y Cajal, Hospital Ramón y cajal, Hospital ramón y Cajal.
Nº: C2019-528
Aut@r o Autores: C. Campos Ferrer, C. Picón Serrano, M. Garcia Gomez Muriel, C. Sempere Ortega3, R. Romera Sanchez4, A. Vicente Bartulos.
Presentación
A 73-year-old male with a history of gastric adenocarcinoma in remission. Carrier of multiple esophageal endoprothesis by esophageal-yeunal fistula and subsequent stenosis. He attended the emergency department for fever of 5 days evolution and right hemiparesis without radiological evidence of stroke. He presents bad clinical evolution with progressive neurological and hemodynamic deterioration that requires admission to the ICU. During admission, he presented frank hematemesis without the possibility of endoscopic study due to the stenosis described, requesting urgent multiphase CT. Findings: Diverticular lesion dependent on the posterior wall of the left atrium in intimate contact with the upper edge of the esophageal prosthesis.
Discusión
The findings suggested left atrial pseudoaneurysm in relation to esophageal prosthesis as an injury mechanism. The diagnosis would explain the patient's clinic (fever, neurological alterations and hematemesis). This is an infrequent entity described mostly as complications of radiofrequency ablation for treatment of atrial fibrillation. We have found no bibliographic references in the literature outside of this clinical context.
Conclusión
Pseudoaneurysms in unusual locations should be a diagnosis to be considered in patients with mediastinal pathology not necessarily traumatic with clinically compatible (fever, neurological alterations and bleeding).
Bibliografía
- Zuluaga Santamaria, A et al .Aneurismas, pseudoaneurismas y divertículos cardiacos. .Rev. Colomb. Radiol 2017, 28(1): 4593-9. - Schuring , C A et al .Atrio-esophageal fístula: A case series and literature review. Am J Case Rep 2017 .Aug ,