An uncommon complication of staphylococcal pneumonia: pneumopericardium with cardiac tamponade

Abstract

A 1-year-old girl presented with a 3-day history of fever, cough, and dyspnoea. A chest radiograph demonstrated consolidation in the right upper lobe ( figure 1A). Laboratory tests showed leucocytosis and blood culture showed oxacillin-sensitive Staphylococcus aureus. A radiograph performed 12 days later (figure 1B) showed pneumatocoele formation. On the 25th day, the patient's condition worsened abruptly, with hypotension. A chest radiograph ( figure 1C, D) showed pneumopericardium. Pericardiocentesis was performed, but the child died 2 days later. Tension pneumopericardium has a very high mortality rate in the absence of early recognition and acute intervention. If there is evidence of tamponade, pericardiocentesis is essential. 2Contributors CC, EM and GZ planned the study. GZ and BH conducted a survey. EM submitted the study. CC and EM are responsible for the overall content as guarantors. GZ and BH collected the data. GZ and BH analysed and interpreted the samples and the data. CC and EM wrote the manuscript. All authors revised and approved the final version of the manuscript.Competing interests None. Patient consent Obtained.Ethics approval The ethics committee/institutional review board waived the approvation.Provenance and peer review Not commissioned; internally peer reviewed.

Nontraumatic tension pneumopericardium in nonventilated pediatric patients: a review

“…Due to its rare nature, pneumopericardium in children has previously been discussed only in the context of case reports and therefore data on epidemiology are limited. The first description of pneumopericardium appears in an article by Bricheteau in 1844 and isolated cases have been described ever since . Our review is a synthesis of the available evidence and suggests that patients in the first month of life and children undergoing cardiothoracic or abdominal surgery, or with a previous history of hematological disease, and presenting with isolated pneumopericardium are at higher risk of tension pneumopericardium, which presents with a higher mortality compared with patients with other air leak syndromes.…”

“…Tension pneumopericardium affects only a minor percentage of patients but results in significant hemodynamic instability . There are very limited data available on nontraumatic pneumopericardium in pediatric patients who are nonventilated …”

Multiple cystic lung disease

“…Honeycombing, found in patients with end-stage pulmonary fibrosis, appears as multiple rows of air-filled spaces clustered in the subpleural region, predominantly in the lower lobes and typically <1 cm in diameter [3]. Pneumatoceles manifest on CT as scattered, thin-walled, gas-filled cysts interspersed with normal lung in areas previously affected by pneumonia, especially that caused by Staphylococcus aureus or trauma [2,109]. Finally, a cavity is differentiated from a lung cyst by the presence of a thick wall (generally >4 mm).…”