"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Case report
peer-reviewed

Delayed Presentation of Cerebral Air Embolism from a Left Atrial-Esophageal Fistula: A Case Report and Review of the Literature



Abstract

Air embolism developing from an atrial-esophageal fistula that was created as a complication from an atrial ablation procedure is a rare, yet usually fatal diagnosis. Neurologic manifestations such as meningitis, altered mental status, seizures, strokes, transient ischemic attacks (TIAs), psychiatric changes, and coma can ensue. Imaging of the brain might reveal infarcts, cerebral edema, as well as signs of pneumocephalus. This case describes a 42-year-old male with recent cardiac ablation procedure at an outside hospital for refractory atrial fibrillation (A-fib) who presented with altered mental status, dyspnea and diaphoresis. His initial head computed tomography (CT) scan revealed pneumocephalus. He was started on a heparin drip for a non-ST elevation myocardial infarction (NSTEMI), but developed severe coagulopathy. The patient’s mental status quickly deteriorated. Given recent cardiac ablation procedure, the cause of his air embolism was thought to be from a created left atrial-esophageal fistula. Despite medical management, he was too unstable to undergo any surgical intervention for his atrial-esophageal fistula or to transfer to a hyperbaric oxygen therapy center, and expired on the second day following his hospital admission. To our knowledge, few reports have been published in the literature describing delayed cerebral air embolism from an atrial-esophageal fistula. Prompt diagnosis, hyperbaric oxygen therapy, and surgical intervention are essential to avoid mortality in these patients. This article aims to increase awareness of such a rare, but significant complication.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Case report
peer-reviewed

Delayed Presentation of Cerebral Air Embolism from a Left Atrial-Esophageal Fistula: A Case Report and Review of the Literature


Author Information

Catherine Peterson Corresponding Author

Department of Neurosurgery, Wayne State University, Detroit, MI 48202

Clay Elswick

Neurosurgery, Wayne State University School of Medicine

Vicki Diaz

Neurosurgery, Wayne State University School of Medicine

R. Shane Tubbs

Neurosurgery, Seattle Science Foundation

Marc Moisi

Neurosurgery, Seattle Science Foundation

Neurosurgery, Wayne State University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Delayed Presentation of Cerebral Air Embolism from a Left Atrial-Esophageal Fistula: A Case Report and Review of the Literature


Figures etc.

Share
Case report
peer-reviewed

Delayed Presentation of Cerebral Air Embolism from a Left Atrial-Esophageal Fistula: A Case Report and Review of the Literature

Catherine Peterson">Catherine Peterson , Clay Elswick">Clay Elswick, Vicki Diaz">Vicki Diaz, R. Shane Tubbs">R. Shane Tubbs, Marc Moisi">Marc Moisi

  • Author Information
    Catherine Peterson Corresponding Author

    Department of Neurosurgery, Wayne State University, Detroit, MI 48202

    Clay Elswick

    Neurosurgery, Wayne State University School of Medicine

    Vicki Diaz

    Neurosurgery, Wayne State University School of Medicine

    R. Shane Tubbs

    Neurosurgery, Seattle Science Foundation

    Marc Moisi

    Neurosurgery, Seattle Science Foundation

    Neurosurgery, Wayne State University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 15, 2017

    DOI

    10.7759/cureus.1850

    Cite this article as:

    Peterson C, Elswick C, Diaz V, et al. (November 15, 2017) Delayed Presentation of Cerebral Air Embolism from a Left Atrial-Esophageal Fistula: A Case Report and Review of the Literature. Cureus 9(11): e1850. doi:10.7759/cureus.1850

    Publication history

    Received by Cureus: October 26, 2017
    Peer review began: October 27, 2017
    Peer review concluded: November 10, 2017
    Published: November 15, 2017

    Copyright

    © Copyright 2017
    Peterson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Air embolism developing from an atrial-esophageal fistula that was created as a complication from an atrial ablation procedure is a rare, yet usually fatal diagnosis. Neurologic manifestations such as meningitis, altered mental status, seizures, strokes, transient ischemic attacks (TIAs), psychiatric changes, and coma can ensue. Imaging of the brain might reveal infarcts, cerebral edema, as well as signs of pneumocephalus. This case describes a 42-year-old male with recent cardiac ablation procedure at an outside hospital for refractory atrial fibrillation (A-fib) who presented with altered mental status, dyspnea and diaphoresis. His initial head computed tomography (CT) scan revealed pneumocephalus. He was started on a heparin drip for a non-ST elevation myocardial infarction (NSTEMI), but developed severe coagulopathy. The patient’s mental status quickly deteriorated. Given recent cardiac ablation procedure, the cause of his air embolism was thought to be from a created left atrial-esophageal fistula. Despite medical management, he was too unstable to undergo any surgical intervention for his atrial-esophageal fistula or to transfer to a hyperbaric oxygen therapy center, and expired on the second day following his hospital admission. To our knowledge, few reports have been published in the literature describing delayed cerebral air embolism from an atrial-esophageal fistula. Prompt diagnosis, hyperbaric oxygen therapy, and surgical intervention are essential to avoid mortality in these patients. This article aims to increase awareness of such a rare, but significant complication.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Catherine Peterson

Department of Neurosurgery, Wayne State University, Detroit, MI 48202

For correspondence:
catherine.peterson@wayne.edu

Clay Elswick

Neurosurgery, Wayne State University School of Medicine

Vicki Diaz

Neurosurgery, Wayne State University School of Medicine

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Marc Moisi, M.D.

Neurosurgery, Seattle Science Foundation

Catherine Peterson

Department of Neurosurgery, Wayne State University, Detroit, MI 48202

For correspondence:
catherine.peterson@wayne.edu

Clay Elswick

Neurosurgery, Wayne State University School of Medicine

Vicki Diaz

Neurosurgery, Wayne State University School of Medicine

R. Shane Tubbs, Ph.D., Professor

Neurosurgery, Seattle Science Foundation

Marc Moisi, M.D.

Neurosurgery, Seattle Science Foundation