Case Presentation
A 62-year-old man with a history of malignant glomus tumor of the
trachea status post distal tracheal stenting and salvage chemotherapy
presented to the emergency room with chest pain. Initial work-up
revealed a pneumonia and new-onset atrial fibrillation for which he was
admitted for management. Transthoracic echocardiography showed a large
circumferential pericardial effusion without tamponade physiology. A
percutaneous pericardiocentesis was done with removal of 400 ml of
pericardial fluid, of which fluid analysis showed an exudate with
positive cultures. The patient was treated with appropriate intravenous
antibiotics and the pericardial drain was removed 48 hours later. A
follow-up chest computed tomography (CT) showed air in the mediastinum
and pericardium (Figure 1, panel A) and visualized a tracheopericardial
fistula (Figure 1, panel B) resulting from anterior distal tracheal wall
ulceration by the tracheal malignancy. After discussion with the
patient, a bronchoscopy was performed by the interventional pulmonary
team for palliative removal of the tracheal mass and re-stenting of the
trachea to block the fistulous connection. The patient continued to
stabilize as spontaneous absorption of the air occurred and the
infection was treated, and was eventually discharged home with
palliative care.