Cerebral arterial air emboli after stent insertion in esophageal cancer complicated with esophago‐left atrial fistula: An autopsy case and review of the literature

• Published in: Pathology international Vol. 69; no. 11; pp. 662 - 666
• Main Authors: Park, Jong Kun, Goto, Takayoshi, Nagano, Teruaki, Yoshimura, Michiko, Yutani, Chikao
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.11.2019
• Subjects: Autopsies; Autopsy; Cancer; cerebral arterial air embolism; Chemoradiotherapy; Chemotherapy; Computed tomography; Consciousness; Dysphagia; Embolism; Embolisms; Esophageal cancer; esophageal stent insertion; esophago‐left atrial fistula; Esophagus; Fatalities; Fistula; Fistulae; Implants; Literature reviews; Palliation; Stents; Surgical implants; Thorax; esophageal cancer; esophageal stent insertion; cerebral arterial air embolism; esophago-left atrial fistula
• ISSN: 1320-5463; 1440-1827
• DOI: 10.1111/pin.12849

Cerebral arterial air embolism is a rare and unexpected complication of advanced esophageal cancer. The entry of air to systemic circulation is an esophago‐left atrial or pulmonary vein fistula formation. Herein, we report an autopsy case of a 64‐year‐old man. He was diagnosed esophageal cancer 2 years ago and underwent chemotherapy and concurrent chemoradiotherapy but the disease progressed, unfortunately. Then two metal stents were inserted into the middle thoracic esophagus as a palliation of dysphagia. After initiation of oral intake, he developed deterioration of consciousness. The cranial computed tomography showed cerebral arterial air emboli with multiple low‐density areas. He failed to gain consciousness again and died one and half days later. In a literature survey, this autopsy case is the first presentation that confirmed histologically the close association between stent placement and formation of esophago‐left atrial fistula. Due to the fatality of cerebral arterial air embolism, clinicians should keep in mind the possibility of this catastrophic complication after multimodality treatment of esophageal cancer.