[Esophagopericardial fistula occurring at the 22nd years after operation for achalasia presenting as myopericarditis].

We describe a case of pneumopericardium that resulted from esophagopericardial fistula occurring at the 22nd years after operation for achalasia in a 52-year-old male. Atypical features on initial examination suggested myopericarditis or congestive heart failure. A chest roentgenogram and computed tomography revealed development of pneumopericardium. Subsequent emergent pericardiocentesis relieved cardiac tamponade and enabled us to diagnose pyopneumopericardium and esophagopericardial fistula in postoperative period. The esophagopericardial fistula was surgically closed. However, the patient died 2 weeks postoperation of hemorrhage from duodenal ulcer. Autopsy confirmed the pre-mortem diagnosis of esophagopericardial fistula without evidence of malignancy. Early diagnosis and subsequent treatment appears to be most important. This case report reinforces the difficulty of this diagnosis and perhaps the need for clinical awareness and inclusion of this entity in a differential diagnosis.