Gastropericardial fistula as a late complication of Roux-en-Y procedure.

Pneumopericardium secondary to gastro-pericardial fistula is a rare complication associated with various surgical procedures and conditions, notably Roux-en-Y gastric bypass. This condition poses a risk of cardiac tamponade and can be fatal if not promptly diagnosed and managed. We present a case of a 62-year-old female with a history of gastric bypass who presented with nonspecific symptoms and was eventually diagnosed with pneumopericardium secondary to gastro-pericardial fistula. Despite efforts for timely intervention, including transfer to a facility with cardiothoracic surgery availability, the patient's unstable condition precluded surgical intervention, leading to her eventual demise. A literature review reveals that the average time from Roux-en-Y gastric bypass surgery to presentation is nine years. The elusive nature of the presentation underscores the importance of a comprehensive clinical history in identifying this condition early. Awareness of gastro-pericardial fistula as a potential late complication of gastric bypass is crucial for timely diagnosis and intervention to improve patient outcomes.

Bronchopericardial Fistula: A Rare Complication of Necrotizing Pneumonia.

Pneumopericardium due to bronchopericardial fistula formation is a rare complication secondary to necrotizing pneumonia. Several such cases are reported due to different suppurative bacterial infections. Persistent fistulous communication has been reported to lead to tension pneumopericardium and hemodynamic instability, requiring urgent intervention such as pericardial drainage. A 41-year-old male patient, known to have chronic kidney disease and diabetes mellitus, presented with acute respiratory symptoms. Upon admission, the patient was febrile and required oxygen support via nasal prongs. A chest X-ray showed fibrocavitatory changes on the right side, with patchy air shadowing around the cardiac silhouette and a continuous diaphragm sign. A contrast-enhanced computed tomography (CECT) thorax revealed extensive areas of consolidation with necrotic areas within, forming a thin-walled cavity involving the right middle lobe. Also, suspicious communication of this cavity with the pericardial cavity along the right atrium was seen, with minimal pericardial collection and air foci within. The pleural fluid culture showed growth of Klebsiella pneumoniae. According to the antibiotic sensitivity report, the patient was started on IV meropenem and gentamicin for 21 days while monitoring kidney functions. The patient clinically improved on antibiotics, and follow-up radiological investigations showed resolution of pneumopericardium. In this patient, pneumopericardium was mild, and there was no evidence of tension pneumopericardium. Thus, conservative management with antibiotics was provided, with successful resolution. Unlike this case, if evidence of tension pneumopericardium had been present, emergency interventions for decompression would have been required, and these cases would have had a poor prognosis. This case demonstrates the importance of high suspicion and early diagnosis of pneumopericardium in patients with necrotizing pneumonia. Prompt treatment in these patients can prevent further life-threatening sequelae.

Gastropericardial fistula: A successfully operated heart code.

Gastropericardial fistula is a rare, extremely serious and life-threatening condition. Its most common aetiology is secondary to iatrogenic injury following gastric surgery. Clinical manifestations may be non-specific with precordial pain, simulating an acute coronary syndrome, and may be accompanied by electrocardiogram abnormalities. Diagnosis is made by thoracoabdominal computed tomography (CT) with oral and intravenous contrast. Treatment is surgical and consists of repair of the anomalous communication. We present the case of an 81-year-old male patient with gastropericardial fistula who underwent surgery, with the aim of reviewing the diagnosis and the appropriate therapeutic strategy.

Spontaneous Pneumothorax, Pneumomediastinum, and Pneumopericardium in an HIV Patient With Tuberculosis: A Rare Trio.

A trio of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax is a highly unusual presentation. The majority of reported cases are due to trauma, while the remaining cases are iatrogenic. Among infections, this trio has so far been reported in COVID-19 pneumonia and pneumocystis pneumonia in HIV-positive patients. There are case reports on pneumothorax and pneumomediastinum in tuberculosis, but the trio is not reported. Here, we present a case of a recently diagnosed HIV-positive patient with complaints of cough and shortness of breath whose initial workup was negative for Mycobacterium. The patient was, however, started on antitubercular drugs based on clinical radiological evidence. He developed spontaneous pneumothorax, pneumomediastinum, and pneumopericardium, and repeat bronchoalveolar lavage (BAL) came positive for Mycobacterium. The patient, however, could not be revived and succumbed to obstructive and septic shock.

Spontaneous pneumomediastinum and pneumopericardium in a young male with asthma.

INTRODUCTION: Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity. CASE STUDY: Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck. RESULTS: The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home. CONCLUSION: This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium.

Pneumopericardium in a child - "halo sign" on chest x-ray: A Case Report.

A 5 year old boy with acute ly mphoblastic leukaemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general anaesthesia. H is ches t x-ray was remarkabl e for a promin ent halo sign, an air gap surrounding the he art indicat ing a large pneumope ricardium. Alth ough the pneu mo pericardium could not be appre ciated on an echocardiogram, the child developed clinical sig ns of cardiac t amponade. Attem pts to evacu ate the pneumopericardium were unsuccessful leading to death.

Purulent Bacterial Pericarditis: Rare Yet Lethal.

Bacterial pericarditis is a rare phenomenon that progresses rapidly and carries high mortality. Patients presenting with new pericardial effusions are often evaluated for concomitant rheumatologic, oncologic, and infectious diseases. We present a complex case of purulent pericarditis with pneumopericardium.

Traumatic Right Atrium Perforation Causing a Pneumothorax and Pneumopericardium, Treated Conservatively.

Pacemaker insertion is a daily occurrence in the United States of America, and it is a relatively common procedure; however, complications can occur. One common complication includes the development of a pneumothorax; however, there are rare instances where patients can develop a pneumopericardium as well. We present a case of a patient who underwent dual chamber pacemaker implantation complicated by a pneumothorax and left-sided pneumopericardium, which is a rare finding. This patient initially presented with syncopal episodes and a dual chamber pacemaker was inserted; however, not long after, the patient developed pericarditis and was found to have a pneumothorax and a pneumopericardium. In these cases, patients can be treated with chest tube insertion, lead extraction, or even conservatively, depending on the patient's clinical status. Various reasons exist for the development of a pneumothorax and pneumopericardium; however, the guidelines on management are still unclear and require further study. In our patient, his pneumothorax and contralateral pneumopericardium were treated conservatively with stable follow-up post-hospitalization.

Evidence of Pneumopericardium after Elective Ovariectomy in a Peritoneopericardial Diaphragmatic Hernia-Affected Dog: A Case Report.

Peritoneopericardial diaphragmatic hernia (PPDH) is an opening between the pericardial sac and the pleuroperitoneal membrane. Pneumopericardium is an infrequent complication of PPDH. This condition is a serious circumstance in which free gas accumulates in the pericardial sac. The present report describes the occurrence of pneumopericardium and pericardial effusion after elective ovariectomy in a dog affected by PPDH. The presence of an umbilical and diaphragmatic hernia was highlighted during ovariectomy, and a pneumopericardium was seen during an X-ray exam. At the time of admission to the hospital, the dog was asymptomatic. The diagnosis was performed by X-ray and ultrasonographic exams. Computed tomography examination confirmed the diagnosis and directed for a surgical approach of the congenital defect. Surgery resulted in resolution of PPDH and of pneumopericardium.

Pneumopericardium following severe thoracic trauma.

BACKGROUND: Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a pneumothorax, interstitial air tracking along the pulmonary perivascular sheaths from ruptured alveoli to the pericardium, or direct trachea-bronchial-pericardial communication.  Our objectives were to describe the modern management approach to PPC and to identify variables that could improve survival with severe thoracic injury. METHODS: We conducted a retrospective study of the trauma registry between 2015 and 2022 at a Level I verified adult trauma center for all patients with PPC. Demographics, injury patterns, and treatment characteristics were compared between blunt and penetrating trauma. This study focused on the management strategies and the physiologic status regarding PPC and the development of tension physiology. The main outcome measure was operative versus nonoperative management. RESULTS: Over a seven-year period, there were 46,389 trauma admissions, of which 488 patients had pneumomediastinum. Eighteen patients were identified with PPC at admission. Median age was 39.5 years (range, 18-77 years), predominantly male (n = 16, 89 %), Black (n = 12, 67 %), and the majority from blunt trauma (78 %). Half had subcutaneous emphysema on presentation while 39 % had recognizable pneumomediastinum on chest x-ray. Tube thoracostomy was the most common intervention in this cohort (89 %). Despite tube thoracostomy, tension PPC was observed in three patients, two mandating emergent pericardial windows for progression to tension physiology, and the remaining requiring reconstruction of a blunt tracheal disruption. The majority of PPC patients recovered with expectant management (83 %), and no deaths were directly related to PPC. CONCLUSIONS: Traumatic PPC is a rare radiographic finding with the majority successfully managed conservatively in a monitored ICU setting. These patients often have severe thoracic injury with concomitant injuries requiring thoracostomy alone; however, emergent surgical intervention may be required when PPC progresses to tension physiology to improve overall survival.