Air in the pericardial sac post tracheostomy: One should be aware

Abstract

Pneumopericardium is a rare clinical presentation and is an unusual complication of tracheostomy. Its isolated presentation without associated air in other potential space such as mediastinum or pleura causes difficulty in diagnosis especially in patient with invasive ventilation. We report a case of 72-year-old lady who developed isolated pneumopericardium following tracheostomy. The progression into cardiac tamponade was halted by administration of fluid resuscitation and modifying ventilation mode to spontaneous setting. A flexometallic endotracheal tube was inserted through the tracheostomy stoma with the aid of fibre-optic scope while she was breathing spontaneously; and the cuff was inflated distal to the site of the tracheal wall injury. This technique successfully ceased the air leak across the injury. The endotracheal tube was changed to an adjustable flange tracheostomy tube size 8.5mm internal diameter once available and subsequent serial chest radiographs showed resolving pneumopericardium. Based on this case, we believed that a prompt diagnosis of isolated pneumopericardium may prevent its catastrophic progression into a fatal cardiac tamponade and thus, these rare findings were reported with the intention to raise awareness amongst clinicians.