Esophageal-left atrial fistula: an unsual cause.

A 55-year-old male presented with progressive dyspnea, swelling of legs and abdominal distension for past one week. Routine investigation showed presence of large pericardial effusion. Pericardiocentesis tapped a yellow colored sterile fluid with predominant polymorphs. However sequence of events following pericardiocentesis were unusual as patient developed stroke. MRI brain and CECT thorax were done. MRI brain showed small infarct and CECT showed presence of open safety pin eroding through esophagus and communicating with left atrium with thrombus and an air pocket within. Patient developed progressive encephalopathy and CT brain revealed multiple infarcts with pneumocephalus.