Nontraumatic tension pneumopericardium in nonventilated pediatric patients: a review.

BACKGROUND AND AIMS: Pneumopericardium is a rare air leak syndrome caused by the abnormal presence of air in the pericardial sac, with a high risk of morbidity and mortality. It is clinically divided into nontension and tension pneumopericardium, with the latter resulting in a decreased cardiac output and circulatory failure. There are limited data regarding nontraumatic pneumopericardium in nonventilated pediatric patients. Therefore, we aimed to describe a case of tension pneumopericardium and review the available literature. METHODS: Case report and literature review of nontraumatic pneumopericardium in nonventilated pediatric patients. RESULTS: A 2-month-old infant developed cardiac tamponade secondary to tension pneumopericardium 11 days after cardiac surgery promptly resolved with pericardium drainage. We reviewed the literature on this topic and retrieved 50 cases, of which 72% were nontension whereas a minority were tension pneumopericardium (28%). Patients with tension pneumopericardium were mostly neonates (35.7% vs 22.2%), presented with an isolated air leak (64.3% vs 36.1%), and had a history of surgery (28.6% vs 8.3%) or hematological disease (28.6% vs 11.1%). In all nontension cases, treatment was conservative, whilst in all other cases, pericardiocentesis/pericardium drainage was carried out. There was a high survival rate (86.0%), which was lower in patients with tension pneumopericardium (71.4% vs 91.6%). CONCLUSIONS: Pneumopericardium is a rare condition with a higher mortality rate in patients with tension pneumopericardium, which requires immediate diagnosis and treatment. In nonventilated patients, tension pneumopericardium occurred more frequently in neonates, as an isolated air leak, and in those with a history of surgery or hematological disease.

[Thoracic endometriosis complicated with pneumopericard and iterative pneumothorax due to bullous dystrophy]. / Endométriose thoracique compliquée de pneumopéricarde et pneumothorax itératifs sur dystrophie bulleuse.

Thoracic endometriosis is a rare entity characterized by presence of endometrial tissue in pleura, lung parenchyma or airways. Most frequent manifestations are catamenial pneumothorax, hemothorax, hemoptysis and pulmonary nodules. We report here a rare case of a woman with thoracic endometriosis who developed iterative pneumothorax and pneumopericardium on bilateral bullous pulmonary dystrophy. She was a 37-year-old woman without any tobacco exposure and with previous history of pleural tuberculosis treated 5 years earlier. She was first referred to our centre for right pleuro-pneumothorax and hemorrhagic ascites. Pleural fluid examinations did not show any tuberculosis relapse, the evolution was favorable after thoracic drainage and there was no parenchymal lung abnormality on CT scan after surgery. Celioscopic peritoneal examination revealed stage IV peritoneal endometriosis. One year later, she was admitted for left catamenial pneumothorax. Thoracic CT scan showed apparition of large subpleural bulla. She underwent thoracotomy for bulla resection and left partial pleurectomy. Two years later, she was hospitalized for right pneumothorax and compressive pneumopericardium. Surgical lung biopsies confirmed pleuropulmonary endometriosis. Thoracotomy was performed for talcage pleurodesis and diaphragmatic leakages sutures. Lung bulla are rare in thoracic endometriosis, mechanism of their formation remains unknown. Pericardial involvement is rare in endometriosis; we report here a unique case of pneumopericardium.

Serial chest films are needed after a diagnosis of pneumopericardium because of risk of cardiac herniation.

A 76-year-old man was transferred to our institution with blunt chest trauma after falling off a roof. Chest computed tomography (CT) revealed left pneumothorax and pneumopericardium but no displacement of the heart into the hemithorax. These findings suggested traumatic pericardial rupture without cardiac herniation. After chest drainage, a follow-up CT scan demonstrated no pericardial or pleural air. At thoracotomy, we observed that the pericardium was torn and that the heart was exposed. The tear was repaired with direct sutures. This case report highlights the importance of reviewing the initial CT scan.

A pain in the neck.

Colonoscopy is a generally safe test whose use is rapidly increasing; complications are unusual and the accepted rate of perforation after diagnostic colonoscopy is between 1 in 800-1500 cases. Colonoscopic perforation may not be recognised at the time and the patient may present to a variety of medical practitioners after discharge from hospital. The presentation is usually with abdominal pain. We report an unusual presentation of colonoscopic perforation in which the patient attended the Emergency Department complaining of a painful neck.

Cerebral air embolism caused by a bronchogenic cyst.

An unusual case is presented of a tourist who developed fatal cerebral air embolism, pneumomediastinum and pneumopericardium while ascending from low altitude to Europe's highest railway station. Presumably the air embolism originated from rupture of the unsuspected bronchogenic cyst as a result of pressure changes during the ascent. Cerebral air embolism has been observed during surgery, in scuba diving accidents, submarine escapes and less frequently during exposure to very high altitude. People with known bronchogenic cysts should be informed about the risk of cerebral air embolism and surgical removal should be considered. Cerebral air embolism is a rare cause of coma and stroke in all activities with rapid air pressure changes, including alpine tourism, as our unfortunate tourist illustrates.

Massive subcutaneous emphysema, pneumomediastinum, and pneumopericardium in children.

Massive subcutaneous emphysema (SE), pneumomediastinum (PM), and pneumopericardium (PP) are rare conditions in the pediatric population. Air leak syndrome is a constellation of disorders that include SE, PM, PP, and pulmonary interstitial emphysema. In children, SE, PM, and PP are associated with obstructive airway disease most often in the case of asthma. Management may be conservative or involve invasive procedures that require surgical intervention. Here, we describe a case of massive SE, PM, and PP in a 10-year-old child after placement of a peripherally inserted central line and review the literature.

Pneumopericardium and esophagopericardial fistula presenting as pericarditis in a 1-year-old boy.

Esophagopericardial fistula (EPF) is an uncommon complication of esophageal disease. Although, the esophagus is in direct contact with the pericardium in the lower thoracic vertebrae level, EPF is still rare. Recorded causes of EPF include ingested foreign bodies such as fish bone, benign ulceration in association with hiatus hernia, esophageal carcinoma, and achalasia. Congenital EPF occurs even less but with a high ratio of mortality and misdiagnosis. We present a case of PEF in a 1-year-old boy. It is unique in that the patient was a very young child which is rarely reported in literature and the main cause factor seemed to be repeated vomiting since birth. However, he had a good outcome with surgical treatment.

Pneumopericardium in a patient with AIDS.

In 1997, a 53-year-old male smoker was admitted for progressive shortness of breath associated with a productive cough and yellowish sputum, pleuritic chest pain, and low-grade fever. There was no history of trauma. A posterior-anterior chest radiograph showed a diffuse infiltrate through the right lung field and an air space parallel to the lateral border of the heart. A computed tomographic scan of the chest confirmed pneumopericardium, with no associated pericardial effusion. It also showed a cavitary infiltrate in the anterior basal segment of the right lower lobe, but no definite neoplasm. Cultures of the sputum grew Staphylococcus aureus. The patient had positive antibodies to human immunodeficiency virus (HIV), hepatitis A, and hepatitis B. A bronchial biopsy from the right lower lobe showed well differentiated infiltrating squamous cell carcinoma with an acute inflammatory exudate. No bronchopericardial fistula was noted. After antibiotic treatment, a repeat chest radiograph showed resolution of pneumopericardium and improvement of the chest infiltrate. Repeat computed tomography of the chest showed that the pneumopericardium had resolved, but now revealed a large pericardial effusion. No bronchopericardial fistula could be demonstrated. Unfortunately, our patient refused further investigation. Pneumopericardium is a rare disorder. In adults, pneumopericardium most commonly results from trauma. Although many other reports link pneumopericardium to an underlying disease process, our patient with HIV antibodies developed pneumopericardium despite having no history of trauma and no documentation of a communicating fistula. To our knowledge, there has been no previous report of pneumopericardium in association with acquired immunodeficiency syndrome.

[A case of interstitial pneumonia in the upper lung field histologically diagnosed as nonspecific interstitial pneumonia complicated by bilateral pneumothorax].

A 55-year-old man was admitted to our hospital because of progressive dyspnea. Chest radiography showed interstitial shadows in the upper lobe. The pathological diagnosis of lung biopsy specimens obtained from upper and middle lobes by video-assisted thoracoscopy was non-specific interstitial pneumonia, group 2. Administration of glucocorticoids improved the symptoms, the chest radiography findings, and the serum KL-6 level. This patient may belong to the new category of idiopathic interstitial pneumonia, though he exhibited several features of idiopathic pulmonary upper lobe fibrosis originally described by Amitani et al.

Concurrent pneumopericardium and pneumothorax complicating lung cancer: a case report.

The coexistence of pneumothorax and pneumopericardium in patients with primary lung cancer is a very rare phenomenon. We report one such case, in which squamous cell carcinoma of the lung was complicated by pneumopericardium and pneumothorax. Several explanations of the mechanisms involved will be discussed.

Neuropericardio y neumomediastino por inhalación de cocaina

Se presentan dos pacientes que consultaron a nuestra institución por dolor pericardial luego de gran consumo de de cocaína inhalada. En ambos casos se descartó infarto agudo de miocardio; por los métodos convencionales y ecocardiografía se documentó neumoparicardio y neumomediastino.

Cardiac tamponade resulting from pneumopericardium: case report and implications for the critical care nurse.

Pneumopericardium resulting in cardiac tamponade may be caused by a variety of phenomena. The onset of cardiac tamponade can indicate the presence of a rare underlying condition. As a rare complication of mechanical ventilation and PEEP, our patient experienced pneumopericardium that resulted in cardiac tamponade. Perhaps the most crucial therapy of all is astute critical care nursing assessment of patients at risk of developing the life-threatening complication of cardiac tamponade. All critical care nurses should know the signs and symptoms of cardiac tamponade. Through accurate data collection, frequent monitoring, and immediate referral to the critical care team for medical diagnosis and treatment, a patient's death can be prevented.