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JACC. Case Reports Oct 2021We present a rare case of iatrogenic pneumopericardium, pneumoperitoneum, and pericarditis after emergency pericardiocentesis for pericardial tamponade. The patient had...
We present a rare case of iatrogenic pneumopericardium, pneumoperitoneum, and pericarditis after emergency pericardiocentesis for pericardial tamponade. The patient had profound bowel distention at the time of the procedure that led to iatrogenic pericardioperitoneal fistula formation along with transverse colon perforation, which manifested later after pericardial drain removal. This condition required repeat pericardiocentesis, laparoscopic colon repair, a long course of antibiotics, and an eventual pericardial window. ().
PubMed: 34693351
DOI: 10.1016/j.jaccas.2021.07.024 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2010Pneumopericardium is defined as the presence of air within the pericardial space. It is an uncommon complication of blunt or penetrating chest trauma and may also occur...
Pneumopericardium is defined as the presence of air within the pericardial space. It is an uncommon complication of blunt or penetrating chest trauma and may also occur iatrogenically. 'Simple' pneumopericardium produces no discernible circulatory compromise; however, simple pneumopericardium may progress rapidly to produce cardiovascular compromise or circulatory collapse, when it is termed 'tension' pneumopericardium. Tension pneumopericardium requires emergent drainage of the pericardial sac. Failure to achieve rapid effective drainage may result in cardiac arrest. Drainage of the pericardial sac may be achieved by either percutaneous or open drainage technique. Formation of a sub-xiphoid pericardial window has been advocated as a rapid and effective means of achieving open drainage. This may be carried out at the bedside with minimal equipment, and the authors advocate this technique as the preferred option for achieving drainage. This case demonstrates the rapid and dramatic deterioration to cardiac arrest of a multiply injured trauma patient with radiologically confirmed pneumopericardium. The effectiveness of open drainage via a sub-xiphoid pericardial window at the bedside with resultant return of spontaneous circulation is also shown. In addition, the pathogenesis and natural history of this uncommon condition are reviewed and the options for management are discussed.
Topics: Accidents, Traffic; Cardiopulmonary Resuscitation; Female; Glasgow Coma Scale; Humans; Life Support Care; Liver; Middle Aged; Pneumopericardium; Stress, Psychological; Tomography, X-Ray Computed
PubMed: 21038130
DOI: No ID Found -
Surgical Case Reports May 2022Congenital pericardial defect (CPD) is found incidentally in cases of pneumothorax. CPD is seen in left side rather than right side and it is not generally known among...
BACKGROUND
Congenital pericardial defect (CPD) is found incidentally in cases of pneumothorax. CPD is seen in left side rather than right side and it is not generally known among thoracic surgeons how the inside of the pericardial space can be seen from the thoracic cavity in cases of pericardial defect.
CASE PRESENTATION
A 52-year-old man with dyspnea was referred to our hospital because of the diagnosis of right pneumothorax. Chest radiography showed a right lung collapse and a pneumopericardium on the left side. Despite insertion of a chest tube, air leakage prolonged, bullectomy at the apex of the right lung was performed under thoracoscopy. During surgery, thoracoscope showed that the right atrium seemed as if it had been a non-pedunculated bulla or cardiac cyst. Heart beating, continuity with the heart, and the absence of respiratory motion could distinguish the right atrium from a bulla, and pericardial defect was confirmed. Preoperatively, the patient had no cardiac symptoms related to the CPD, and therefore, it was determined that a procedure to close the CPD was not necessary. Any complication and recurrence did not occur 6 months after surgery.
CONCLUSIONS
Right pneumothorax with CPD showed right atrium mimicking bulla in surgery. It is important to consider correction of CPD if there are cardiac symptoms at the onset of pneumothorax, and not to misinterpret the right atrium as a bulla.
PubMed: 35616741
DOI: 10.1186/s40792-022-01457-y -
Cureus Apr 2023Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest...
Pneumopericardium (PPC) is a clinical entity defined by the presence of air in the pericardial sac. It occurs mainly in patients who sustain blunt or penetrating chest trauma and may coexist with pneumothorax, hemothorax, rib fractures, and pulmonary contusions. Although it is a strong indicator of cardiac injury and therefore requires immediate attention for possible surgical treatment, it still remains a commonly misdiagnosed condition in the trauma bay. Only a few cases of isolated PPC associated with penetrating chest trauma have been reported to date. We present the case of a 40-year-old man who was stabbed in the anterior chest, specifically in the left subxiphoid area and left forearm. Imaging, which included chest x-ray, chest computed tomography, and cardiac ultrasound, demonstrated the presence of rib fractures in addition to isolated PPC, with no pneumothorax or active bleeding. The patient was managed conservatively and actively monitored for three days and remained hemodynamically stable upon discharge. PPC is an uncommon clinical entity, suggestive of severe thoracic trauma. Clinical features may include chest discomfort and dyspnea, while asymptomatic patients have also been reported. Since it can be monitored by electrocardiograms and cardiac ultrasound, its presence is not an absolute indicator for surgical intervention, while the treatment plan should be based on the patient's clinical indications and symptoms.
PubMed: 37153308
DOI: 10.7759/cureus.37071 -
ESC Heart Failure Feb 2021A 66-year-old man with a history of gastric pull-up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X-ray demonstrated...
A 66-year-old man with a history of gastric pull-up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X-ray demonstrated pneumopericardium. Computed tomography revealed ulceration and abscess in the gastric conduit adjacent to the heart, suggesting gastropericardial fistula. As the patient did not show tamponade physiology, he was conservatively treated with antibiotics. The pneumopericardium diminished; however, he developed effusive-constrictive pericarditis with overt heart failure symptoms. Because pericardiocentesis failed to relieve the symptoms, pericardiectomy was performed. Intraoperative exploration revealed remarkably thickened pericardium and epicardium constituting multiple layers with purulent effusion. Epicardiectomy as well as pericardiectomy were required to achieve the effective reduction of central venous pressure. Perforation of the gastric conduit into the pericardial cavity was identified and repaired. Histopathology demonstrated thickened pericardium composed of hyalinized stroma, collagenous bundles, and infiltration of inflammatory cells. Streptococcus anginosus and Candida tropicalis were identified by culture of the resected tissue.
Topics: Aged; Fistula; Humans; Male; Pericardial Effusion; Pericardiectomy; Pericarditis, Constrictive; Pneumopericardium
PubMed: 33300689
DOI: 10.1002/ehf2.13135 -
Cureus Mar 2022Pneumopericardium in the setting of COVID-19 is a rare incident. Typically, COVID-19 manifests with respiratory failure, cytokine storm, and gastrointestinal and cardiac...
Pneumopericardium in the setting of COVID-19 is a rare incident. Typically, COVID-19 manifests with respiratory failure, cytokine storm, and gastrointestinal and cardiac symptoms. Chest X-ray (CXR) shows patchy peripheral opacities in bilateral lung fields and computed tomography (CT) shows multifocal ground-glass opacities in a COVID-19 patient. However, CXR is relatively less specific when compared to CT. In this case report, we present a case of isolated pneumopericardium (without pneumomediastinum) in a young female patient with COVID-19 pneumonia. Not only is the mechanism of development of pneumopericardium in COVID-19 patients poorly understood, but it is also considered a bad prognostic factor that leads to mortality.
PubMed: 35481291
DOI: 10.7759/cureus.23431 -
Medicine Nov 2018Pneumomediastinum and pneumopericardium refer to conditions in which air exists within the mediastinum and pericardium, respectively. There is the communication between...
RATIONALE
Pneumomediastinum and pneumopericardium refer to conditions in which air exists within the mediastinum and pericardium, respectively. There is the communication between the mediastinum, pericardium, and retroperitoneum. We present the first report of rare complications (pneumomediastinum and pneumopericardium) after retroperitoneal transpsoas lateral lumbar interbody fusion (LLIF) surgery.
PATIENT CONCERNS
A 73-year-old female who underwent LLIF using the retroperitoneal approach complained of dysphagia but no other abnormal symptom after surgery.
DIAGNOSIS AND INTERVENTIONS
A plain chest radiograph (CXR) taken immediately the following surgery did not show any unusual findings but CXR took on postoperative day (POD) 1 indicated pneumopericardium and pneumomediastinum with abnormal air density along the pericardium and mediastinum with subdiaphragmatic air density. A chest computed tomography revealed bilateral pleural effusion and abnormal air density (pneumopericardium and pneumomediastinum) connected to a large amount of air around the aorta and retroperitoneal space (pneumoretroperitoneum).
OUTCOMES
The patient complained of no unusual symptom and the CXR on POD 6 indicated that no air density surrounding the mediastinum and pericardium was found.
LESSONS
Pneumomediastinum and pneumopericardium should be considered possible complications of LLIF using retroperitoneal transpsoas approach. Such a condition may progress to fatal conditions without early recognition and rapid management.
Topics: Aged; Female; Humans; Lumbar Vertebrae; Mediastinal Emphysema; Pneumopericardium; Postoperative Complications; Psoas Muscles; Retroperitoneal Space; Spinal Fusion
PubMed: 30431599
DOI: 10.1097/MD.0000000000013222 -
Circulation Reports Jul 2023
PubMed: 37431513
DOI: 10.1253/circrep.CR-23-0023 -
European Review For Medical and... Aug 2017We report 2 children with Respiratory Syncytial Virus (RSV) infection complicated with spontaneous pneumopericardium (PP) and pneumomediastinum (PM), one also associated...
OBJECTIVE
We report 2 children with Respiratory Syncytial Virus (RSV) infection complicated with spontaneous pneumopericardium (PP) and pneumomediastinum (PM), one also associated with pneumorrhachis (PR).
PATIENTS AND METHODS
Two previously healthy children presented with fever, violent dry cough, dyspnea, and tachypnea. Chest X-ray and CT scans showed sizeable PP and PM in both patients. One of them also presented PR. Children were initially treated with intravenous antibiotics, antipyretics, and a cough sedative. Because of worsening of respiratory distress syndrome, children underwent helmet-delivered CPAP with oxygen supplementation. The patients' clinical conditions quickly improved and they were discharged in good conditions.
RESULTS
Pathogenetic mechanism of spontaneous PP and PM complicating RSV infection could be related to the cough, causing intrathoracic pressure increase and rupture of alveoli near the mediastinal pleura. Nevertheless, RSV seems to play a role in facilitating such complications, attenuating the cough threshold in infected children.
CONCLUSIONS
RSV bronchiolitis can lead respiratory and systemic consequences, so their prompt recognition is essential to establish a fast and adequate therapy, especially control of cough and respiratory distress syndrome treatment.
Topics: Bronchiolitis; Child, Preschool; Cough; Dyspnea; Fever; Humans; Lung; Male; Mediastinal Emphysema; Pneumopericardium; Pulmonary Alveoli; Respiratory Syncytial Virus Infections
PubMed: 28829494
DOI: No ID Found -
Cardiology and Therapy Jun 2013Pneumopericardium, an accumulation of air in the pericardial cavity, occurs very rarely as compared to pneumothorax and pneumomediastinum. Clinical presentation is...
Pneumopericardium, an accumulation of air in the pericardial cavity, occurs very rarely as compared to pneumothorax and pneumomediastinum. Clinical presentation is variable, patients are frequently asymptomatic, and mild cases usually resolve spontaneously. However, it may lead to pericardial tamponade, which requires rapid diagnosis and treatment that can be lifesaving. The traditional diagnostic, simple method of diagnosis is via an upright chest X-ray. Typical findings can be detected and a differential diagnosis can be made between pneumomediastinum and pneumopericardium. Echocardiography and chest computed tomography scans can also support the diagnosis. Only one case of pneumopericardium after surgical pericardiotomy has been reported in the literature so far. In this case report, iatrogenic pneumopericardium, which resolved spontaneously after surgical pericardiotomy, was reported in a 19-year-old patient who had a rejected liver transplantation, and had liver and kidney failure with pericardial tamponade. In this case, pneumopericardium was accompanied by pneumoperitoneum and subcutaneous emphysema; an extremely rare combination.
PubMed: 25135293
DOI: 10.1007/s40119-012-0008-6