-
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023 -
Circulation Reports Jul 2023
PubMed: 37431513
DOI: 10.1253/circrep.CR-23-0023 -
Journal of Geriatric Cardiology : JGC Jun 2023
PubMed: 37416522
DOI: 10.26599/1671-5411.2023.06.008 -
Cureus May 2023Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of...
Pneumopericardium is defined as the collection of air inside the pericardium. Gastro-pericardial fistula is one of its rarest etiologies. We are presenting a case of pneumopericardium due to gastro-pericardial fistula secondary to gastric cancer presented with an inferior ST-elevation myocardial infarction (STEMI)-like picture. Our case is a 57-year-old male with a past medical history of metastatic gastric cancer status post chemotherapy and radiotherapy who presented to the emergency with acute onset severe burning chest pain with radiation to his back. He was diaphoretic, saturating 96% on room air, and hypotensive with a blood pressure of 80/50 mmHg, and his EKG showed sinus rhythm with a heart rate of 60 BPM and ST elevation in inferior leads meeting STEMI criteria. The patient was transferred for an emergency coronary angiogram with possible percutaneous intervention. Surprisingly, no significant lesions in his epicardial vessels would corroborate his clinical presentation and EKG changes. The decision was to obtain CT angiography to exclude aortic dissection and pulmonary embolism. His CT chest revealed a large pneumopericardium with a gastric-pericardial fistula. A nasogastric tube was placed with suctioning of gastric contents. Given his tamponade physiology, it was decided to do emergent pericardiocentesis draining only 20 cc of gastric contents and a significant amount of air. After the procedure, the patient was transferred to the ICU with stable hemodynamics. The case was discussed with surgery, but given his inoperable cancer, a palliative team was involved. Acknowledging his very poor prognosis, the patient requested discharge to home with home hospice. As reported in the literature, pneumopericardium is rare, and gastro-pericardial fistula associated with gastric cancer is even rarer. Clinical presentation is variable and can be confusing. Providers should be aware of how a patient with gastric cancer can be complicated with pneumopericardium, and they should have a lower threshold of suspicion in patients having risk factors. CT scan is the most sensitive tool for diagnosis.
PubMed: 37378126
DOI: 10.7759/cureus.39358 -
Cureus May 2023Radiofrequency ablation (RFA) is a minimally invasive cardiac catheterization procedure employed in patients whose atrial fibrillation (AF) is not well-controlled on...
Radiofrequency ablation (RFA) is a minimally invasive cardiac catheterization procedure employed in patients whose atrial fibrillation (AF) is not well-controlled on medical therapy. While serious complications after the RFA are uncommon, we present the unique case of a 71-year-old male who suffered from acute respiratory distress syndrome (ARDS) and pneumomediastinum post-procedure. He presented to the ED with dyspnea, non-massive hemoptysis, and fever three days following RFA. Admission CT thorax demonstrated patchy ground glass opacities (GGOs) and stable fibrotic changes. He was admitted for suspected pneumonia, however, he failed to significantly improve on broad-spectrum antibiotics. Bronchoscopy found blood in proximal airways, however, lavage with serial aliquots were without worsening hemorrhage, ruling out suspected diffuse alveolar hemorrhage. Cytology resulted in rare iron polymorphonuclear neutrophils and no malignant cells. With worsening clinical status, the patient was eventually intubated. Repeat CT thorax showed new moderate pneumopericardium, small pneumomediastinum, and progressed GGOs. The respiratory course continued to worsen, and the patient passed away approximately one month after admission. We also present a brief literature review with the aim of identifying prognostic risk factors regarding post-RFA ARDS development. Additionally, this case identifies a novel complication of RFA, as post-procedural pneumomediastinum has not been previously described.
PubMed: 37323324
DOI: 10.7759/cureus.39052 -
Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report.Journal of Medical Case Reports Jun 2023Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity...
INTRODUCTION
Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain.
CLINICAL CASE REPORT
A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium.
CLINICAL CONCLUSION
A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.
Topics: Female; Humans; Middle Aged; Pneumopericardium; Pericardial Effusion; Cardiac Tamponade; Dyspnea; Rectal Neoplasms
PubMed: 37264442
DOI: 10.1186/s13256-023-03935-9 -
Journal of Cardiovascular... Jun 2023Atrial lead perforation may lead to pneumopericardium or pneumothorax within a few days of device implantation.
BACKGROUND
Atrial lead perforation may lead to pneumopericardium or pneumothorax within a few days of device implantation.
METHODS AND RESULTS
We report a case of atrial lead perforation 6 years after cardiac resynchronization therapy implantation, which resulted in pneumopericardium and pneumothorax.
CONCLUSION
Although pneumopericardium caused by atrial lead perforation can spontaneously resolve with conservative treatment, as it did in this case, treatment should be decided based on the patient's general condition and lead performance.
Topics: Humans; Pacemaker, Artificial; Atrial Fibrillation; Pneumopericardium; Pneumothorax; Heart Injuries
PubMed: 37222178
DOI: 10.1111/jce.15930 -
CMAJ : Canadian Medical Association... May 2023
Topics: Humans; Pneumopericardium; Pericardium
PubMed: 37220925
DOI: 10.1503/cmaj.221137-f -
The American Surgeon Sep 2023Pneumopericardium is an exceptionally uncommon phenomenon in the setting of blunt polytrauma. It is imperative for trauma providers to identify tension pneumopericardium...
Pneumopericardium is an exceptionally uncommon phenomenon in the setting of blunt polytrauma. It is imperative for trauma providers to identify tension pneumopericardium despite its rarity. A 22-year-old male motorcyclist presented to the hospital after colliding with a car going approximately 50 mph. The patient was hemodynamically unstable and had diminished breath sounds bilaterally. Bilateral chest tubes were placed, yielding little improvement in condition. While obtaining CT imaging, pneumopericardium was promptly identified. Pulses were lost immediately before pericardiocentesis, and resuscitative thoracotomy was performed. The pericardial sac was tense and an immediate gush of air released upon incising the sac. The patient was taken immediately to the Operating Room for further exploration and repair.
Topics: Male; Humans; Young Adult; Adult; Pneumopericardium; Shock, Cardiogenic; Thoracic Injuries; Pericardiocentesis; Wounds, Nonpenetrating
PubMed: 37158506
DOI: 10.1177/00031348231175125