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Esophageal-atrial fistula
Insights
A rare esophageal-atrial fistula developed in a scleroderma patient, causing a cerebral abscess. This critical complication, often missed antemortem, highlights the need for vigilance in patients with chronic esophageal issues.
Area of Science:
- Gastroenterology and Cardiology
- Connective Tissue Diseases
Background:
- Scleroderma, a systemic autoimmune disease, can affect multiple organs, including the esophagus.
- Barrett's esophagus is a known complication of chronic acid reflux, often associated with scleroderma-related esophagitis.
Observation:
- An unusual case of an esophageal-atrial fistula is presented in a patient with the CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma.
- A perforated ulcer in the Barrett's esophagus led to the fistula, connecting the esophagus to the left atrium.
Findings:
- The fistula resulted in systemic embolization and a subsequent cerebral abscess, a severe neurological complication.
- Review of literature reveals a pattern of chronic esophageal pathology, gastrointestinal bleeding, and neurological signs in similar cases.
Implications:
- This case underscores the potential for rare but life-threatening complications arising from esophageal pathology in systemic sclerosis.
- The lack of antemortem diagnosis in reported cases suggests a need for increased awareness and diagnostic consideration of esophageal-atrial fistula in at-risk patients.
Abstract:
We report an unusual case of an esophageal-atrial fistula in a patient with CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma. An ulcer in Barrett's esophagus perforated into the left atrium and led to systemic embolization and cerebral abscess. A review of similar reports of esophageal-atrial fistula reveals a symptom complex that includes chronic esophageal pathology, gastrointestinal bleeding, and neurological signs. An antemortem diagnosis has never been made.