Cerebral Air Emboli from an Atrioesophageal Fistula

Cerebral air emboli that result from a fistula between the left atrium and the esophagus are a rare but known complication, with a very high mortality, after left atrial radiofrequency ablation for medically refractory atrial fibrillation. A rapid diagnosis is essential to increase the survival of these patients. Cardiac CT is the best imaging study to demonstrate the atrioesophageal fistula and air within the left cardiac chambers. A CT of the brain may show air within the intracranial arteries, most commonly in the right middle cerebral artery distribution, whereas MR imaging of the brain will best demonstrate the multifocal embolic infarctions.