Esophagoatrial fistula with previous pericarditis complicating esophageal ulceration. Report of two cases and a review of the literature.

Sixteen cases of nontraumatic left atrial-esophageal fistulas have been reported previously. These fistulas usually result from chronic peptic esophagitis or cancer. The diagnosis is suggested by the triad of chronic dysphagia, hematemesis, and acute neurologic signs. There may be cardiac manifestations such as pericarditis, atrial fibrillation, or shock. An unusual feature of these fistulas is systemic embolization of food, air, or septic necrotic debris which may result in sudden central nervous system symptoms. All reported cases resulted in death due to hemorrhage, although there was often a variable time interval between the onset of hematemesis and the patient's death. The authors report two additional cases in which an episode of pericarditis preceded fistula development. Based on these 18 cases, the spectrum of esophagoatrial fistulas is reviewed, as well as the signs which may herald fistula development.