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.