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Published on: September 24, 2021
Purulent Pericarditis and Tamponade From a Migrating Esophageal Foreign Body
Ziad R Hindosh1, Beda M Cha2, Jonathan Soverow1
1Department of Medicine, Division of Cardiology, Olive View-UCLA Medical Center, Los Angeles, California, USA.
Background:
Purulent pericarditis is rare, typically affecting immunocompromised individuals from hematogenous spread, contiguous extension, or direct inoculation. Esophageal foreign body migration as an etiology has not been previously described.
Case Summary:
A 42-year-old immunocompetent male presented with pleuritic chest pain and dysphagia after ingestion of a tripe burrito. He developed hemodynamic instability from cardiac tamponade. Emergent pericardiocentesis was performed, yielding fluid that grew Streptococcus constellatus. Computed tomography and esophagogastroduodenoscopy identified a penetrating foreign body in the distal esophagus. He improved following video-assisted pericardial washout and antibiotic therapy. Follow-up imaging demonstrated migration of the object between the thoracic aorta and azygos vein.
Discussion:
Rare cases of purulent pericarditis in immunocompetent patients have been reported via respiratory translocation; however, this appears to be the first reported case of purulent pericarditis due to esophageal foreign body migration. Multidisciplinary consensus supported conservative management rather than surgical pericardiectomy and led to a full recovery.
Take-Home Messages:
Early recognition of purulent cardiac tamponade due to foreign body ingestion, along with prompt pericardiocentesis and antibiotic therapy, was critical for stabilization and individualized management.
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Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
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Pericarditis I: Introduction
Pericarditis II: Clinical Features and Diagnostic Tests
Pericarditis III: Medical Management
Pericarditis IV: Nursing Management