Near-Fatal Pneumopericardium During Tracheal Stent Exchange.

PATIENTS WITH BRONCHIAL FISTULAS, including bronchopleural, bronchomediastinal, bronchopericardial, or bronchoesophageal, may present with significant difficulties in airway and ventilatory management. Fistulas are an infrequent, but well-described complication, of metal airway stents, and in the setting of advanced malignancy, communication with the mediastinal or pericardial space may occur. When these fistulas are present, positive-pressure ventilation has a high likelihood of developing cardiac tamponade, which may be catastrophic if diagnosis and management are delayed. The authors present a rare case of stent migration and fistula formation into the pericardial space that presented with acute intraoperative hemodynamic and respiratory decompensation, which never has been described in the literature.