Affiliation:
1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
Abstract
Abstract
Background
Pneumopericardium is an uncommon clinical finding. It most commonly occurs after chest trauma but can also emerge as a complication following interventional or surgical procedures and can result in life-threatening complications. A high index of clinical suspicion should be present and once the condition is recognized, it should be managed promptly. Paucity of literature on pneumopericardium makes outlining any new case of paramount importance to emphasize the aspects of diagnosis and management of this rare condition.
Case summary
A 59-year-old woman with severe mitral valve and moderate tricuspid valve regurgitation underwent mitral and tricuspid valve repair with uneventful post-operative in-hospital stay. She presented 10 days after discharge with progressive shortness of breath. Chest X-ray revealed right hydropneumothorax. Transthoracic echocardiography (TTE) performed in the emergency department showed an apparently small pericardial effusion with patient in supine position; the effusion size increased substantially when imaging in left lateral decubitus, with presence of intrapericardial air bubbles. Computed tomography scan of the chest confirmed the presence of right hydropneumothorax and hydropneumopericardium, with a communicating pleuro-pericardial tract. The patient underwent chest tube placement which successfully decompressed both pleural and pericardial space.
Discussion
Hydropneumopericardium is a rare post-operative complication. Comprehensive TTE with imaging from multiple acoustic windows is mandatory when evaluating the extent of pericardial effusion. Presence of cardiac tamponade is crucial in determining the management plan.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine
Reference8 articles.
1. Pneumopericardium resulting in cardiac tamponade;Cummings;Ann Thorac Surg,1984
2. Tension pneumopericardium and pneumothorax during spontaneous ventilation;Petteruti;J Thorac Cardiovasc Surg,2007
3. Tension pneumopericardium after blunt chest trauma;Gould;Ann Thorac Surg,2001
4. Pneumopericardium;James;Am Med,1904
5. The treatment of tuberculous pericarditis with effusion by injection of air and lipiodol into the pericardial sac;Ackermann;Am Rev Tuberc,1929