Pneumopericardium

Abstract

A 32-year-old kidney transplant recipient presented with Klebsiella pneumonia. He developed sudden tension pneumothorax with pneumopericardium on chest radiography ( Figure 1). Pericardiocentesis revealed a continuous flow of air from the pigtail catheter, raising suspicion of a broncho-pleuro-pericardial fistula. Computed tomography confirmed the findings, although a fistula could not be demonstrated ( Figure 2). Despite prompt treatment with broadspectrum antimicrobials and drainage, the patient's condition deteriorated and he died after 3 days. Pneumopericardium is an emergency, presenting as cardiac tamponade with mortality > 50%. The etiology is traumatic, post-thoracic surgery, infectious (gasproducing organisms) or broncho-pericardial fistulas. It is diagnosed by the halo sign on chest radiography and confirmed by computed tomography. Tension pneumopericardium calls for fluid resuscitation and urgent pericardiocentesis. Spontaneous resorption usually occurs in 2 weeks. In our case, the exact etiology was unknown, but infectious etiology is a possibility.