Delayed Constrictive Pericarditis Following Presumed Esophagopericardial Communication After Esophageal Stenting.

Esophagopericardial fistula is a rare but life-threatening complication of esophageal stenting and malignancy. Although acute purulent pericarditis is a well-recognized consequence, delayed presentation as constrictive pericarditis years after the initial insult is exceptionally uncommon. A 74-year-old woman presented with a two-month history of progressive dyspnea. She had undergone esophageal stent implantation for esophageal cancer two years earlier, followed by chemoradiotherapy. Transthoracic echocardiography demonstrated preserved biventricular systolic function and constrictive physiology without significant pericardial effusion. Chest computed tomography revealed dense pericardial fluid containing air bubbles, raising suspicion of an esophagopericardial communication. However, contrast-enhanced computed tomography with both oral and intravenous contrast failed to demonstrate an active fistulous tract. Cardiac magnetic resonance imaging confirmed constrictive physiology with septal bounce. The patient underwent surgical pericardiectomy, during which a large amount of firm, white, cheese-like purulent material was evacuated. Microbiological culture of the pericardial specimen grew