Traumatic Pneumopericardium
Davide Agnelli
Intensive Care Unit, Department of Cardiology, Sacra Famiglia Hospital, Erba, Italy
Pneumopericardium is a rare but potentially life threatening disorder, due to the presence of air in the pericardial space. In premature infants, pneumopericardium can be a complication of respiratory distress syndrome when that condition requires prolonged positive pressure ventilation. In adults, however, the most common causes are iatrogeny in diagnostic and therapeutic procedures, as well as traumatic lesions. The documented mortality is very high.
Recognition of pneumopericardium is of paramount importance because it can lead to cardiac tamponade, which requires emergent pericardiocentesis. We present a case of pneumopericardium in a teenager following closed chest trauma. Electrocardiography showed normal sinus rhythm with J-point elevation in all leads (Panel A).
Antero-posterior view of chest X-ray revealed curvilinear radiolucent stripes along silhouette on left cardiac borders, suggesting the presence of air within the pericardial sac (Panel B). Computed tomography of the chest was performed and showed lung contusion, pneumothorax, and pneumopericardium, with no associated pericardial effusion (Panel C and D). Pneumopericardium and pneumothorax were resolved with a percutaneously placed drain in the pleural space.
Figure legend
Panel A: Electrocardiography, taken on admission, shows normal sinus rhythm with J-point elevation across all leads. This pattern is consistent with acute pericarditis.
Panel B: Chest X-ray: cardiac silhouette was sharply identified by the presence of pneumopericardium (arrow).
Panel C and D: Computed tomographic findings demonstrate post-traumatic pneumopericardium, with no associated pericardial effusion. Air within the pericardium is suspected when the pericardial sac itself can be visualised.
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