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      Pneumopericardium as a Complication of Pericardiocentesis

      case-report

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          Abstract

          Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.

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          Tuberculous pericarditis.

          Bongani M Mayosi, A F Doubell, Jefferey L. Burgess (2005)
          The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous pericarditis. We searched MEDLINE (January 1966 to May 2005) and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy. Research is needed to improve the diagnosis, assess the effectiveness of adjunctive steroids, and determine the impact of HIV infection on the outcome of tuberculous pericarditis.
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            Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review.

            Bradley Ramsay, R Graeni, Benjamin Peter … (2002)
            In pneumopericardium, a rare but potentially life threatening differential diagnosis of chest pain with a broad variety of causes, rapid diagnosis and adequate treatment are crucial. In upright posteroanterior chest radiography, the apical limit of a radiolucent rim, outlining both the left ventricle and the right atrium, lies at the level of the pulmonary artery and ascending aorta, reflecting the anatomical limits of the pericardium. The band of gas surrounding the heart may outline the normally invisible parts of the diaphragm, producing the continuous left hemidiaphragm sign in an upright lateral chest radiograph. If haemodynamic conditions are stable, the underlying condition should be treated and the patient should be monitored closely. Acute haemodynamic deterioration should prompt rapid further investigation and cardiac tamponade must be actively ruled out. Spontaneous pneumopericardium in a 20 year old man is presented, and its pathophysiology described.
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              A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Young Adult

              Young-Jung Lee, Seung-Won Jin, Sung-Hee Jang … (2001)
              Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): May 2011
                Publication date (Electronic): 31 May 2011
                Volume: 41
                Issue: 5
                Pages: 280-282
                Affiliations
                Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                Author notes
                Correspondence: Woo Seung Shin, MD, Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 65-1 Gumo-dong, Uijeongbu 480-821, Korea. Tel: 82-31-820-3996, Fax: 82-31-847-2719, medsws@ 123456catholic.ac.kr
                Article
                DOI: 10.4070/kcj.2011.41.5.280
                PMC ID: 3116108
                PubMed ID: 21731571
                SO-VID: 4498d4ce-609b-466b-a2f4-daeec57994b8
                Copyright © Copyright © 2011 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 July 2010
                Date revision received : 28 September 2010
                Date accepted : 13 October 2010
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pneumopericardium,pericardiocentesis
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pneumopericardium, pericardiocentesis

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