An acute chest pain revealing an inflammatory pericarditis

Excerpt

A 70-year-old woman suffering from Hashimoto disease and an autoimmune hepatitis presented to the emergency department for a febrile chest pain appeared during a meal 4 days earlier. The admission biology revealed a systemic inflammatory syndrome, a cardiomegaly on chest X-ray and the echocardiography revealed a two-centimeter heterogeneous and circumferential pericardial effusion. The chest computed tomography scan (see Fig. 1) confirmed the heterogeneous circumferential pericardial effusion, associated with an anterior pneumopericardium. A spontaneously hyperdense linear opacity was observed between the posterior pericardium, just behind the left atrium, and the posterior mediastinum in front of the esophagus, in axial plan. A posterior pleural effusion with local atelectasis was present. The coronal plan allowed us to confirm the same opacity, below the left branch of the pulmonary artery, associated with an air density opacity in front of the esophagus, extending in front of the aorta. The opacity corresponded to a splinter of chicken bone confirmed by surgical ablation. Eso-pericardial perforation by a foreign body (most often by fish bone rather than a chicken bone) is a rare but severe complication and must be especially considered in purulent pericarditis.

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