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Clinical Practice and Cases in... May 2021Although rare, iatrogenic cases of pneumopericardium have been documented following laparoscopic surgery and mechanical ventilation. Electrocardiogram (ECG) changes,...
INTRODUCTION
Although rare, iatrogenic cases of pneumopericardium have been documented following laparoscopic surgery and mechanical ventilation. Electrocardiogram (ECG) changes, including ST-segment depressions and T-wave inversions, have been documented in cases of pneumopericardium, and can mimic more concerning causes of chest pain including myocardial ischemia or pulmonary embolism.
CASE REPORT
This unique case describes a patient who presented with chest pain and ST-segment changes on ECG hours after a laparoscopic inguinal hernia repair and who was found to have pneumopericardium.
CONCLUSION
While iatrogenic pneumopericardium is often self-limiting and rarely requires intervention, it is critical to differentiate pneumopericardium from other etiologies of chest pain, including myocardial ischemia and pulmonary embolism, to prevent unnecessary intervention.
PubMed: 34436999
DOI: 10.5811/cpcem.2021.2.51069 -
Case Reports in Gastroenterology 2017Colon perforation is an uncommon but serious complication of colonoscopy. It may occur as either intraperitoneal or extraperitoneal perforation or in combination. The... (Review)
Review
Colon perforation is an uncommon but serious complication of colonoscopy. It may occur as either intraperitoneal or extraperitoneal perforation or in combination. The majority of colonic perforations are intraperitoneal, causing air and intracolonic contents to leak into the peritoneal space. Rarely, colonic perforation can be extraperitoneal, leading to the passage of air into the retroperitoneal space causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. A literature review revealed that 31 cases of extraperitoneal perforation exist, out of which 20 cases also reported concomitant intraperitoneal perforation. We report the case of a young female with a history of ulcerative colitis who developed combined intraperitoneal and extraperitoneal perforation after colonoscopy. We also report the duration of onset of symptoms, clinical features, imaging findings, site of leak, and treatment administered in previously reported cases of extraperitoneal colonic perforation.
PubMed: 28559786
DOI: 10.1159/000475750 -
Annals of Medicine and Surgery (2012) Jan 2022An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous... (Review)
Review
BACKGROUND
An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data.
METHODS
A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3.
RESULTS
We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS.
CONCLUSION
COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.
PubMed: 35003730
DOI: 10.1016/j.amsu.2021.103221 -
Heart & Lung : the Journal of Critical... 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Mediastinal Emphysema; Pandemics; Pneumonia, Viral; Pneumopericardium; SARS-CoV-2
PubMed: 32980170
DOI: 10.1016/j.hrtlng.2020.09.006 -
Cureus Nov 2020Pneumopericardium is a rare clinical condition defined by the presence of air in the pericardial sac. While this initially does not pose much danger, the accumulation of...
Pneumopericardium is a rare clinical condition defined by the presence of air in the pericardial sac. While this initially does not pose much danger, the accumulation of a sufficient amount of air can convert the pneumopericardium to a tension pathology. This may present with the classic signs, symptoms, and lethal dangers of cardiac tamponade. As with cardiac tamponade, treatment involves decompression of the pericardial sac through pericardiocentesis. This may be followed by insertion of a pericardial tube for continued drainage. While cardiac tamponade is well recognized by its classic findings, the rarer pneumopericardium may be more easily missed. This is further complicated by the backdrop of concurrent traumatic injuries in which it typically presents, as well as the absence of the defining accumulated pericardial effusion. We present a case of a 38-year old male who developed pneumopericardium and worsening hemodynamic status as a complication to blunt trauma, a rare etiology for this condition. CT of the chest demonstrated air in the pericardium and a coexisting pneumothorax. A bedside chest tube was placed. Upon resolution of the pneumothorax, his hemodynamic status improved. Repeat bedside ultrasound demonstrated complete resolution of his pneumopericardium. This case emphasizes the importance of early recognition and diagnosis of this rare yet easily missed condition.
PubMed: 33376639
DOI: 10.7759/cureus.11625 -
Revista Portuguesa de Cardiologia :... Oct 2022
PubMed: 36253226
DOI: 10.1016/j.repc.2021.09.021 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023 -
Clinical Imaging May 2022To determine the incidence and clinical predictors of intrathoracic complications in COVID-19 patients, and the association with outcomes.
PURPOSE
To determine the incidence and clinical predictors of intrathoracic complications in COVID-19 patients, and the association with outcomes.
METHODS
In this retrospective cross-sectional study, we included 976 patients (age 61 ± 17 years, 62% male) who tested positive for SARS-CoV-2 between March 3-April 4, 2020 and underwent chest imaging. 3836 radiographs from 976 patients and 105 CTs from 88 patients were reviewed for intrathoracic complications, including pneumothorax, pneumomediastinum, pneumopericardium, lobar collapse, pleural effusion, and pneumatocele formation.
RESULTS
There was a high rate of intrathoracic complications (197/976, 20%). Pleural effusion was the most common complication (168/976, 17%). Pneumothorax (30/976, 3%) and pneumatoceles (9/88, 10%) were also frequent. History of hypertension and high initial CXR severity score were independent risk factors for complications. Patients with any intrathoracic complication during admission had an over 11-fold risk of ICU admission (adjusted odds ratio [aOR] 11.2, p < 0.0001) and intubation (aOR 12.4, p < 0.0001), over 50% reduction in successful extubation (aOR 0.49, p = 0.02) and longer length of stay (median 13 versus 5 days, p < 0.0001). There was no difference in overall survival between patients with and without any complication (log-rank p = 0.94).
CONCLUSION
In COVID-19 patients who underwent chest imaging, 1 in 5 patients have an intrathoracic complication, which are associated with higher level of care and prolonged hospital stay. Hypertension history and high CXR severity score confer an increased risk of complication.
SUMMARY
Intrathoracic complications in COVID-19 are common and are predictive of ICU admission, need for intubation, less successful extubation, and longer length of stay but are not predictive of mortality.
Topics: Adult; Aged; COVID-19; Cross-Sectional Studies; Female; Humans; Incidence; Male; Middle Aged; Respiratory Distress Syndrome; Retrospective Studies; SARS-CoV-2
PubMed: 35278869
DOI: 10.1016/j.clinimag.2022.02.029 -
Texas Heart Institute Journal Sep 2021
Topics: Humans; Pacemaker, Artificial; Pneumopericardium; Prosthesis Implantation
PubMed: 34665870
DOI: 10.14503/THIJ-19-7093 -
Indian Journal of Thoracic and... Jul 2019Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without...
Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without any underlying cause in a healthy adult. Pneumopericardium following pericardiocentesis has been rarely reported in the literature. Pneumopericardium is often self-resolving and rarely requires a pericardial drain for treatment. We report a case of pneumopericardium presented with tamponade physiology following pericardiocentesis for tubercular pericardial effusion, requiring emergency pericardiectomy.
PubMed: 33061035
DOI: 10.1007/s12055-018-00785-9