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BMJ Case Reports Apr 2024
Iatrogenic postintubation tracheal perforation in a patient with acute asthma exacerbation complicated with subcutaneous emphysema, pneumomediastinum, pneumopericardium, pneumothorax and pneumoperitoneum.
Topics: Humans; Mediastinal Emphysema; Pneumothorax; Pneumopericardium; Pneumoperitoneum; Subcutaneous Emphysema; Asthma; Iatrogenic Disease
PubMed: 38565225
DOI: 10.1136/bcr-2023-258934 -
Cureus Feb 2024Pacemaker insertion is a daily occurrence in the United States of America, and it is a relatively common procedure; however, complications can occur. One common...
Pacemaker insertion is a daily occurrence in the United States of America, and it is a relatively common procedure; however, complications can occur. One common complication includes the development of a pneumothorax; however, there are rare instances where patients can develop a pneumopericardium as well. We present a case of a patient who underwent dual chamber pacemaker implantation complicated by a pneumothorax and left-sided pneumopericardium, which is a rare finding. This patient initially presented with syncopal episodes and a dual chamber pacemaker was inserted; however, not long after, the patient developed pericarditis and was found to have a pneumothorax and a pneumopericardium. In these cases, patients can be treated with chest tube insertion, lead extraction, or even conservatively, depending on the patient's clinical status. Various reasons exist for the development of a pneumothorax and pneumopericardium; however, the guidelines on management are still unclear and require further study. In our patient, his pneumothorax and contralateral pneumopericardium were treated conservatively with stable follow-up post-hospitalization.
PubMed: 38516485
DOI: 10.7759/cureus.54566 -
JACC. Case Reports Apr 2024Bacterial pericarditis is a rare phenomenon that progresses rapidly and carries high mortality. Patients presenting with new pericardial effusions are often evaluated...
Bacterial pericarditis is a rare phenomenon that progresses rapidly and carries high mortality. Patients presenting with new pericardial effusions are often evaluated for concomitant rheumatologic, oncologic, and infectious diseases. We present a complex case of purulent pericarditis with pneumopericardium.
PubMed: 38465283
DOI: 10.1016/j.jaccas.2024.102282 -
European Heart Journal. Cardiovascular... Mar 2024
PubMed: 38462964
DOI: 10.1093/ehjci/jeae065 -
ACG Case Reports Journal Mar 2024A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric...
A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric fullness after eating a bony fish. A diagnosis of gastroesophageal reflux disease was made. After a week of progressive worsening of her symptoms, she was referred to the specialist hospital. There, computed tomography imaging strongly suggested that a likely fishbone had penetrated the esophagus into the mediastinal structures; it seemed to have produced a pneumopericardium. Other tests suggested diffuse changes in ventricular repolarization, pericardial thickening, and diastolic restriction. Exploratory thoracotomy confirmed esophageal-pericardial perforation by the fishbone and purulent pericarditis. Despite appropriate surgical repair, the patient died on fifth postoperative day from an asystolic cardiac arrest that was refractory to repeated attempts to resuscitate her.
PubMed: 38445259
DOI: 10.14309/crj.0000000000001291 -
Animals : An Open Access Journal From... Feb 2024Peritoneopericardial diaphragmatic hernia (PPDH) is an opening between the pericardial sac and the pleuroperitoneal membrane. Pneumopericardium is an infrequent...
Peritoneopericardial diaphragmatic hernia (PPDH) is an opening between the pericardial sac and the pleuroperitoneal membrane. Pneumopericardium is an infrequent complication of PPDH. This condition is a serious circumstance in which free gas accumulates in the pericardial sac. The present report describes the occurrence of pneumopericardium and pericardial effusion after elective ovariectomy in a dog affected by PPDH. The presence of an umbilical and diaphragmatic hernia was highlighted during ovariectomy, and a pneumopericardium was seen during an X-ray exam. At the time of admission to the hospital, the dog was asymptomatic. The diagnosis was performed by X-ray and ultrasonographic exams. Computed tomography examination confirmed the diagnosis and directed for a surgical approach of the congenital defect. Surgery resulted in resolution of PPDH and of pneumopericardium.
PubMed: 38396601
DOI: 10.3390/ani14040633 -
Clinical Research in Cardiology :... Feb 2024Epicardial ablation has become an integral part of the treatment of ventricular tachycardias (VT). This study reports the safety of epicardial access as well as the...
BACKGROUND
Epicardial ablation has become an integral part of the treatment of ventricular tachycardias (VT). This study reports the safety of epicardial access as well as the efficacy of epicardial ablation of structural heart disease in a tertiary single-center experience.
METHODS
Between January 2016 and February 2022, consecutive patients undergoing an epicardial access for VT ablation were included. Different puncture techniques and occurrence of epicardial access-related complications as well as the safety of ablation using non-ionic 5% dextrose in water (D5W) compared to standard 0.9% normal saline (NS) irrigation were analyzed. VT recurrence rates during a mean follow-up of 37 ± 23 months were reported.
RESULTS
In total, 197 patients undergoing a total of 239 procedures were included (59.8 ± 15.3 years, 86% males). A total of 154 patients (78%) had non-ischemic cardiomyopathies with a mean LVEF of 37 ± 14. Anterior-oriented epicardial access was aimed for in all cases and was successful in 217 (91%) of all procedures, whereas access was achieved in 19 procedures (8%) only using an inferior oriented access and in three procedures (1%) using surgical access due to severe adhesions or anatomical requirements. Overall epicardial puncture-related complications occurred in 18 (8%) of all procedures with minor pericardial bleeding in nine, pericardial tamponade in one, pneumothorax in five, pneumopericardium in one, and abdominal puncture in two cases. Presence of adhesions could be identified as the only independent predictor of epicardial access-related complications. D5W was used in 79 cases and regular 0.9% saline in 117 procedures. No differences were seen regarding acute ablation success or complications. During follow-up, 47% of all patients were free from any VTs (56% D5W vs. 40% NS; log-rank p = 0.747) and 92% of clinical VTs (98% D5W vs. 91% NS; log-rank p = 0.139).
CONCLUSIONS
In this large single-centre experience, epicardial access and ablation were safe and feasible. Although long-term clinical VT recurrence rates were low, overall VT recurrences as well as mortality were high advocating for a highly experienced, interdisciplinary approach including intense management of underlying cardiac disease/heart failure. Routine usage of D5W was safe and associated with comparable short- or long-term clinical or overall VT freedom.
PubMed: 38324039
DOI: 10.1007/s00392-024-02378-6 -
Cureus Dec 2023Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence...
Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence is 1 in 100,000 births and predominantly affects young primiparous women with prolonged labour. Patients commonly present with subcutaneous emphysema, chest pain, and dyspnoea. We present the case of a 20-year-old primigravida female with no other medical history who had prolonged labour at 43 weeks gestation. Sudden-onset, right-sided cheek pain and swelling was noted immediately after delivery accompanied by pleuritic chest pain. Chest X-ray (CXR) and computed tomography (CT) demonstrated significant pneumomediastinum and pneumopericardium with subcutaneous emphysema extending to the neck. She was managed symptomatically in addition to antibiotics and discharged after three days with complete resolution of symptoms. No concerns were raised during the follow-up. HS is a rare phenomenon that can occur during labour, particularly in young primiparous females with a prolonged second stage. Radiological investigations in the form of CXR and CT are recommended to rule out life-threatening complications and other conditions that may require immediate management. HS occurs due to rupture of peripheral alveoli secondary to increased intrathoracic pressures from excessive Valsalva manoeuvre allowing air to dissect and enter into the mediastinum. Pneumopericardium in association with HS is extremely rare. It is particularly clinically important because it can cause cardiac tamponade requiring immediate surgical management. HS is otherwise a self-limiting condition and management is symptomatic only. Our case is unique due to the presence of pneumopericardium in association with HS, the fourth ever reported in the literature. Due to its rarity, the incidence of tamponade in this cohort of patients is yet to be delineated.
PubMed: 38249191
DOI: 10.7759/cureus.50850 -
The Journal of Emergency Medicine Feb 2024
Topics: Humans; Pneumopericardium; Tomography, X-Ray Computed; Peptic Ulcer
PubMed: 38242752
DOI: 10.1016/j.jemermed.2023.08.015 -
Injury May 2024Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a...
BACKGROUND
Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a pneumothorax, interstitial air tracking along the pulmonary perivascular sheaths from ruptured alveoli to the pericardium, or direct trachea-bronchial-pericardial communication. Our objectives were to describe the modern management approach to PPC and to identify variables that could improve survival with severe thoracic injury.
METHODS
We conducted a retrospective study of the trauma registry between 2015 and 2022 at a Level I verified adult trauma center for all patients with PPC. Demographics, injury patterns, and treatment characteristics were compared between blunt and penetrating trauma. This study focused on the management strategies and the physiologic status regarding PPC and the development of tension physiology. The main outcome measure was operative versus nonoperative management.
RESULTS
Over a seven-year period, there were 46,389 trauma admissions, of which 488 patients had pneumomediastinum. Eighteen patients were identified with PPC at admission. Median age was 39.5 years (range, 18-77 years), predominantly male (n = 16, 89 %), Black (n = 12, 67 %), and the majority from blunt trauma (78 %). Half had subcutaneous emphysema on presentation while 39 % had recognizable pneumomediastinum on chest x-ray. Tube thoracostomy was the most common intervention in this cohort (89 %). Despite tube thoracostomy, tension PPC was observed in three patients, two mandating emergent pericardial windows for progression to tension physiology, and the remaining requiring reconstruction of a blunt tracheal disruption. The majority of PPC patients recovered with expectant management (83 %), and no deaths were directly related to PPC.
CONCLUSIONS
Traumatic PPC is a rare radiographic finding with the majority successfully managed conservatively in a monitored ICU setting. These patients often have severe thoracic injury with concomitant injuries requiring thoracostomy alone; however, emergent surgical intervention may be required when PPC progresses to tension physiology to improve overall survival.
Topics: Adult; Humans; Male; Female; Pneumopericardium; Retrospective Studies; Mediastinal Emphysema; Thoracic Injuries; Wounds, Nonpenetrating; Pneumothorax
PubMed: 38218676
DOI: 10.1016/j.injury.2023.111303