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A 47-year-old homeless man presented to the emergency department 1 week after the onset of chest pain. He was hemodynamically stable. The physical examination was unremarkable. A routine complete blood count revealed 27,000 leukocytes per cubic millimeter. A chest radiograph showed pneumopericardium (arrow) without evidence of pneumothorax or pneumomediastinum. A computed tomographic scan of the chest confirmed the diagnosis of pneumopericardium and showed circumferential wall thickening of the distal esophagus with an associated esophagopericardial fistula. Esophagoscopy revealed a deep esophageal ulcer 4.5 cm in diameter, 36 cm from the incisors; the pericardial cavity and the lining of the columnar epithelium . . . [Full Text of this Article] |
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