An unusual case of acute fatal pulmonary congestion: Oesophageal stenting

Extrinsic left atrial compression with consequent hemodynamic compromise has been described secondary to aortic aneurysm, huge gastroesophageal distension and neoplastic diseases involving mediastinum. Prompt correction of the primary pathology usually leads to reversal of hemodynamic alterations. We report the case of a lady, who, in order to treat a stenosis of the lower third of the oesophagus, underwent stenting with subsequent hemodynamic deterioration due to compression of the posterior left atrial wall disclosed by echocardiography. The sudden recovery of the oesophageal lumen at the expense of the left atrial volume with the impossibility of prompt removal of the stent led to a progressive and fatal deterioration of the hemodynamic picture. Stenting of the lower part of the oesophagus should be performed only when reciprocal anatomic relationship between heart and oesophagus itself is clearly elucidated and possibly well maintained.