While nontraumatic esophageal perforation, so-called Boerhaave syndrome, is a well-established entity, it only rarely results in a fistulous communication between the esophagus and the heart, great vessels, or pericardium. We report one such unusual lesion, an esophagealleft atrial fistula. A symptom complex, based on comparisons with previous cases, is described. With this information, future cases may be recognized in time for therapeutic intervention.
A 51-year-old housewife was being followed up for systemic lupus erythematosus of five-years' duration that was manifested by moderate proteinuria and hypertension. She had iatrogenic Cushing syndrome, secondary to prednisone therapy. In addition, she had a 20-year history of hiatus hernia with esophageal reflux and erosive esophagitis that was repeatedly demonstrated radiologically and by esophagoscopy. On antacid therapy, the patient experienced moderate dysphagia and suffered episodes of mild hematemesis once or twice a year. In 1968, examination revealed a distal esophageal stricture, and the patient