Answer: rapid neurological deterioration

Le résumé fourni par la source

This Spot the Diagnosis article refers to ‘Question: rapid neurological deterioration’, by N. Bradt et al., https://doi.org/10.1093/ehjacc/zuae060. The correct answer is 3: CT thorax to exclude atrial–oesophageal fistula. The CT scan of the thorax showed free mediastinal air around the oesophagus as well as air in the left atrium (Figure 1) due to fistulisation between the left atrium and the oesophagus. The full scans can be seen in the Supplementary material. The diagnosis was suspected in this patient due to his history of recent pulmonary vein isolation in combination of fever due to bacteraemia combined with proven septic emboli with cerebral and cutaneous involvement. CT scan of the thorax showing the free mediastinal air (Panel A and B) as well as the air in the left atrium (Panel C and D). The arrows show the pathological collection of air. Atrial–oesophageal fistulisation is a rare complication of pulmonary vein isolation with an estimated incidence of 0.02–0.1%1 and has a high mortality rate of ∼50–83%.1,2 Due to its high mortality and morbidity rate, urgent surgical repair with a patch repair of the left atrium and oesophageal repair is the preferred treatment.3 Supplementary material is available at European Heart Journal: Acute Cardiovascular Care online. There are no financial interests. The data underlying this article are available in the article and in its online Supplementary material.

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