Abdominal Stab Wounds with Tension Pneumopericardium Confirmed by Autopsy and Postmortem Computed Tomography.

We present the first report of pneumopericardium observed by autopsy and on postmortem computed tomography (PMCT) images. The subject was a woman who died of self-inflicted stab wounds to the abdomen. The PMCT scan revealed air in the pericardial sac, a "flattened heart" sign, and retroperitoneal hemorrhage. Medicolegal autopsy revealed two abdominal stab wounds near the xiphoid process that had cut the apical pericardium and adjacent diaphragm and liver. Examination of the open thorax confirmed that the pericardial sac was distended with air. The wound extended to the abdominal aorta, causing retroperitoneal hemorrhage. PMCT images showed that the pneumopericardial volume was 133 mL. We believe that cardiac tamponade occurred resulting from the tension pneumopericardium; however, the effects were mitigated by hypovolemia secondary to the retroperitoneal hemorrhage as well as obstructive shock. Therefore, the cause of death appears to have been low-pressure cardiac tamponade.

Thoracic trauma in fatal falls from height - Traumatic pneumopericardium correlates with height of fall and severe injury.

Pneumopericardium (PPC) describes the collection of gas in the pericardial sac. In tension Pneumopericardium (tPPC), this collection of gas may lead to cardiac tamponade. PPC following blunt trauma is considered a rare finding, as reflected by the low number of case reports on the topic. We analyzed the prevalence and pathophysiology of PPC and the associated trauma in 44 cases of falls from height. We retrospectively analyzed postmortem CT data and autopsy reports of fatal falls in the period March 2014-2017. A valid estimation of the height of the fall and a documented impact on an even and hard surface were inclusion criteria. A total of 44 cases were included in the study. We identified PPC in 18 of the 44 cases, and it was associated with an increased height of the fall, alongside aortic, pericardial, and myocardial ruptures. All cases with PPC also presented with bilateral pneumothorax. Five cases presented with a "ballooning" pericardium, indicating tPPC. PPC is a common finding in cases of falls from great heights. Due to a significant correlation with height and thus impact severity, PPC may be used as a reconstructive element in medico-legal investigations. Association with trauma makes PPC a sign of severe thoracic injury in postmortem and clinical radiology.

Pneumopericardium, pneumomediastinum, pneumothorax and pneumoretroperitoneum complicating pulmonary metastatic carcinoma in a cat.

This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.

Gastropericardial fistula after Roux-en-Y bypass for reflux disease.

A 49-year-old man was admitted to his local hospital with a 3-day history of left-sided chest pain which started after a coughing paroxysm. His surgical history included laparoscopic Toupet fundoplication 30 months earlier and revisional reflux surgery (Roux-en-Y gastric bypass) 11 months earlier. On admission, he was found to be tachycardic at 110 bpm, hypotensive (90/65 mm Hg). He had ST depression in ECG leads V2-5 with a normal troponin I level. Chest radiography indicated a pneumopericardium which prompted referral to the oesophagogastric surgery unit. Endoscopy and CT with oral contrast confirmed a gastropericardial fistula. This was managed by total gastrectomy through a left thoracoabdominal approach. The patient was discharged home 2 months later. We report the fourth case of gastropericardial fistula in the literature as a long-term complication of Roux-en-Y gastric bypass with a favourable outcome and mini literature review.

A case of pneumopericardium following endomyocardial biopsy.

Pneumopericardium is a very rare condition, less common than isolated pneumothorax or pneumomediastinum. Since it can occasionally cause pericardial tamponade, prompt recognition and treatment of this condition is lifesaving. Up to now only one case of isolated pneumopericardium after endomyocardial biopsy has been reported in a two-month boy with a dilated cardiomyopathy of unknown origin. In the current case, we report a 25-year-old man who underwent orthotopic heart transplantation three years ago in whom isolated pneumopericardium occurred following endomyocardial biopsy performed via right internal jugular vein.

Retroperitoneoscopic left donor nephrectomy: use of Hem-o-Lok clips for control of renal pedicle.

PURPOSE: To assess the safety of transplantation with the use of Hem-o-lok clips to control the renal vessels during retroperitoneoscopic donor nephrectomy (RDN). PATIENTS AND METHODS: From September 2004 to August 2005, we performed 45 left RDNs. Forty-one patients had a single renal artery, whereas four had double arteries. All patients had a single renal vein. Both the renal artery and the vein were controlled by 10-mm Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC). Two clips for each artery and vein were applied on the patient side. The technical difficulty in obtaining vascular control, transfusion requirement, and clinical outcome were evaluated. RESULTS: Sufficient length of renal vessels for transplantation was available in all patients. One patient required conversion to open surgery because of an injury to the renal artery during withdrawal of the clip applicator. The mean operative time was 206 minutes, and two patients required blood transfusion. The mean warm ischemia time was 254 seconds (range 134-520 seconds). Postoperatively, one patient had pneumopericardium. The mean postoperative stay was 3.5 days (range 1-8 days). CONCLUSION: Hem-o-lok clips provide reliable vascular control in RDN and yield sufficient vessel length for transplantation.

Miliary tuberculosis with unusual matted giant mesenteric lymph nodes.

We report a case of miliary tuberculosis in a 10-month old female with unusual matted giant mesenteric lymph nodes. She presented with prolonged fever and poor feeding for two months. With the evidence of miliary pattern in chest X-ray and the positive acid-fast bacilli from the sputum, she was treated with antituberculous chemotherapy. She died from pneumomediastinum and pneumopericardium. Post-mortem findings disclosed miliary tuberculosis involving major organs. Acid-fast bacilli were numerous. Large matted mesenteric lymph nodes measuring 10 x 6 x 5 cm3 were noted. A strikingly large palpable matted mesenteric lymph nodes in suspected miliary tuberculosis should not be confused with tumors in the children.

Pneumopericardium complicating amoebic liver abscess. A case report.

Pneumopericardium arises most commonly as a result of a bronchial or oesophageal neoplasm which erodes the pericardial cavity. A case of pneumopericardium associated with amoebic liver abscess, a complication of invasive amoebiasis not previously reported, is described.