Pneumopericardium in Infancy

Abstract

Pneumopericardium is an unusual complication of mediastinal emphysema in infants. It is rarely recognized clinically, yet the symptoms and signs are characteristic, and the prompt relief of the gas tamponade by pericordotomy is lifesaving. Six infants with this condition have been observed in the past 2 years, and all were receiving positive pressure mechanical respiration. Two were recognized clinically, and prompt surgical measures were instituted with success.It is the purpose of this paper to call attention to this condition, discuss the etiology, the signs and symptoms, surgical relief, and prevention. Report of CasesCase 1.\p=m-\Awhite boy, 3\m=1/2\months old was admitted because of progressive enlargement of the head, and studies revealed noncommunicating hydrocephalus. A ventriculoatrial operation was planned, and as the ankle phlebotomy was being performed prior to surgery, under endotracheal anesthesia, the heart sounds became progressively distant. The pulse was quenched, and cardiac arrest occurred. No subcutaneous emphysema was noted. A left thoracotomy was quickly done, and a glistening membrane bulged into the chest wound. There was no pneumothorax, but mediastinal emphysema was present. The distended membrane was identified as markedly distended pericardium filled with gas, which escaped under pressure when this sac was incised. The heart appeared small in its large cavity, and no beat was noted. Manual stimulation reestablished sinus rhythm in a few seconds. The duration of the cardiac arrest was 3 minutes. The pericardium was closed, except for a 2.0 cm. window, and the left chest was closed under water seal. Recovery was without incident, and 12 days later, the ventriculoatrial shunt was carried out without further complication.The child was last seen at one year of age, with the shunt functioning well, and the child starting to stand by himself.

Spontaneous Pneumopericardium in an Otherwise Healthy Full‐term Newborn

“…Air is thought to dissect from ruptured alveoli along perivascular sheaths to the mediastinum (91, and then enter the pericardial space at the reflection of the pulmonary veins (3, 10, 12). At autopsy traumatic tears in the pericardium have never been found (1, 10,12), and there is no explanation to why PPC is sometimes seen as an isolated air-leak. Several forms of congenital pericardial defects are known, and in these patients pneumothorax will usually be followed by a PPC (13), but this has only been reported once in the neonatal period (14).…”

Pneumopericardium in a horse secondary to sternal bone marrow aspiration

“…Various diagnostic and therapeutic procedures have been associated with pneumopericardium, including sternal bone marrow aspiration (Ackerman and Alden 1958), thoracocentesis and paracentesis (Shackelford 1931) and central venous catheterisation (Rivkind et al 1991). The condition is also a well-documented sequela to positive pressure ventilation and barotrauma in infants (Loftis et al 1962;Cohen and Lochart 1970). Traumatic origins include both internally (blunt) and externally derived penetrating chest wounds, and such trauma is one of the most common causes in man (Shackelford 1931;Westaby 1977;Demetriades et al 1990;Capizzi et al 1995;Gould and Schurr 2001;Roth and Schmid 2002).…”

Pneumopericardium and pneumomediastinum complicating endotracheal intubation

“…Since then, other cases have been described of complicating conditions such as hiatus hernia (Monro et al, 1974), oesophagitis (Curry and Anderson, 1974), lung abscess (Netto, 1944) and even dental extraction (Sandler, Libshitz and Marks, 1975). There is in the literature one instance of pneumopericardium following endotracheal intubation for anaesthesia in a 3-5-month-old boy (Loftis et al, 1962). However, most cases of pneumopericardium occur in newborn infants (Moodie et al, 1976), particularly those treated with continuous positive airways pressure (CPAP) or intermittent positive pressure ventilation with positive end-expiratory pressure (PEEP) for IRDS (Mansfield et al, 1973;Matthieu et al, 1970).…”