A Rare Case of an Esophageal-Pericardial Fistula With Large Pericardial Effusion and Pyopneumopericardium in the Setting of Gastric Adenocarcinoma

An esophageal-pericardial fistula (EPF) is a rare, life-threatening complication of esophageal disease, most commonly occurring due to esophageal carcinoma. It can result in pericardial effusion, cardiac tamponade, and air in the pericardium or cardiac chambers, further complicating the clinical course. An EPF usually occurs in esophageal-related cancers and, less commonly, gastric-related cancers. This study presents a case of an EPF in an 86-year-old male with adenocarcinoma of the gastric cardia, complicated by a large pericardial effusion with transient tamponade physiology. Imaging, such as a CT esophagram, confirmed tract communication, and supportive imaging, such as echocardiograms, confirmed complications.