The "airgap" and "swirling bubbles" signs in a patient with esophageal carcinoma

Pneumopericardium is a dreaded complication in esophageal carcinoma.

We report a case of a 62 year old patient with past history of esophageal cancer with pneumopericardium, without hemodynamic compromise. Admission echocardiogram that revealed a pneumopericadium with the presence of the "swirling bubbles" and the "air gap" sign. A small esophagopericardial fistula was postulated as the cause of the pneumopericardium. He underwent esophageal stent placement with almost complete resolution of the pneumopericardium.

Pneumopericardium is usually a sign of marked clinical deterioration in neoplasia and leads to patients' death few weeks. Here we presented a case, in which a more fortunate and unusual outcome happened.

We present a case of a 62 year old patient, with a past history of esophageal cancer with pulmonary metastases undergoing palliative chemotherapy treatment and with two palliative esophageal stents. Other past medical history included active hepatitis B, arterial hypertension and dyslipidaemia. He was an ex smoker of 80 pack-year units.