Spontaneous tension pneumopericardium

Abstract

A 29-year-old man presented to the accident and emergency department complaining of a sudden onset of chest and upper abdominal pain. He had a past history of intravenous drug abuse and a previous stab wound to the left hypochondrium that had required laparotomy. On arrival he was distressed with grunting respiration. Initial chest X-ray showed a pneumopericardium. Despite titrated doses of opiate analgesia he became increasingly distressed, agitated and dyspnoeic. Repeat chest X-ray demonstrated an increase in the volume of air present within the pericardial sac. His clinical condition improved rapidly after needle pericardiocentesis decompression. A water-soluble contrast swallow revealed a diaphragmatic hernia with a filling defect in the greater curve of the stomach and contrast medium entering the pericardial sac. A thoraco-abdominal laparotomy confirmed a pre-existing diaphragmatic defect from the previous stab wound, with surrounding adhesions. A small portion of the stomach had herniated through this defect with a perforated gastric ulcer communicating directly into the pericardial sac.

Pneumopericardium:two case reports and a review

“…Macroperforations of the pericardium may be caused by penetration or blunt trauma and canfollow thoracic or abdominal surgery. 2,5,6,[8][9][10][11] In the first case, a penetrating injury causing a communication between a bronchus and the pericardium was the likely cause of injury. In the experience of the senior author, visualising a communication between bronchus and pericardium during bronchoscopy can be challenging.…”

A rare complication of metastatic lung disease treatment

“…Although pneumopericardium may develop due to high-pressure mechanical ventilation, mediastinal tumors, tuberculosis, or gastro pericardial fistula may also develop iatrogenically due to endomyocardial biopsy or after pacemaker implantation. 2 …”

“…These areas are mostly the pleural space, tracheobronchial tree, or the gastrointestinal tract. 2 , 3 In the literature, there are only a few pneumopericardium cases caused by chemotherapy administered for a metastatic lung disease. Ours is one of them.…”

Successful Laparoscopic Repair of Acute Intrapericardial Diaphragmatic Hernia Secondary to Penetrating Trauma

“…Two of the 82 cases were due to penetrating trauma. Boyce et al 4 reported another case of a stab wound to the left hypochondrium presenting with tension pneumopericardium secondary to perforated gastric ulcer in the pericardial sac several years after the initial injury. This is a report of the fourth case of such hernia after a stab wound.…”