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.

Spontaneous pneumomediastinum associated with subcutaneous emphysema, pneumopericardium and pneumothorax: a rare association complicating measles.

A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications from measles have been reported in every organ system and they may vary by age and underlying conditions. Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, subcutaneous neck and chest region emphysema, and pneumothorax, in a 19-year-old girl with measles. A review of the literature has documented only one previous report of spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in the course of measles, and no previous cases reported the association of pneumomediastinum, subcutaneous emphysema, pneumopericardium and pneumothorax complicating measles.

Recreational use of nitrous oxide causes seizure, pneumothorax, pneumomediastinum, and pneumopericardium: nitrous oxide and its harm, a case report.

Nitrous oxide, commonly known as 'laughing gas', has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium. This case study highlights the potential dangers of recreational abuse of nitrous oxide.

Spontaneous pneumopericardium and pneumomediastinum as atypical complication for SARS-CoV-2.

SARS-CoV-2 (COVID-19) disease is an infection caused by a new emerging coronavirus, the most common clinical manifestations include fever, dry cough, dyspnea, chest pain, fatigue, and myalgia, sometimes it may present with atypical manifestations such as spontaneous pneumothorax and pneumomediastinum that occur in a minority of patients. We report a case of spontaneous pneumopericardium in a 60-year-old male, without comorbidities or a history of trauma, with pneumonia due to SARS-CoV-2.

La enfermedad por SARS-CoV-2 (COVID-19) es una infección causada por un nuevo coronavirus emergente. Las manifestaciones clínicas más comunes incluyen fiebre, tos seca, disnea, dolor de pecho, fatiga y mialgias. En ocasiones puede presentarse con manifestaciones atípicas, como neumotórax espontáneo y neumomediastino, que ocurren en una minoría de pacientes. Reportamos un caso de neumopericardio espontáneo en un varón de 60 años, sin comorbilidad ni antecedente de traumatismo, con neumonía por SARS-CoV-2.

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.

Fístula colopericárdica tras cirugía de reemplazo esofágico: reporte de caso y revisión bibliográfica / Colopericardial fistula after esophageal replacement surgery: case report and literature review

Introducción: La fístula colopericárdica (FCP) constituye una complicación rara de la cirugía de reemplazo esofágico cuya incidencia se desconoce. Por este motivo presentamos el siguiente caso y realizamos una revisión bibliográfica. Caso clínico: Paciente de sexo femenino de 17 años de edad que consulta por dificultad respiratoria y dolor precordial de 5 días de evolución. Antecedentes: atresia esofágica de tipo long gap (esofagostoma y gastrostomía, posterior ascenso colónico). Se diagnostica inicialmente neumonía bilateral. Evoluciona rápidamente a estado de sepsis. En la radiografía de tórax se constata neumopericardio. Estudio contrastado hidrosoluble confirma diagnóstico de fístula colopericárdica. Se instaura tratamiento quirúrgico, a pesar de ello la paciente fallece por distrés respiratorio. Comentario: La FCP es una entidad muy grave, que presenta un alto índice de mortalidad. Se deben conocer las formas de presentación clínica y los métodos complementarios de confirmación diagnóstica para realizar el tratamiento adecuado

Clinical case: 17-year-old female patient of age consults for respiratory distress and precordial pain of 5 days of evolution. Background: Long gap esophageal atresia (esophagostoma and feeding gastrostomy, subsequent colonic graft). Bilateral pneumonia is initially diagnosed. It rapidly evolves to a state of sepsis. On chest x-ray, pneumopericardium is observed. Water-soluble contrasted study confirms diagnosis of colopericardial fistula. Surgical treatment is established, despite this the patient dies due to respiratory distress. Comment: Colopericardial fistula is a very serious entity with a high mortality rate. The clinical presentation and the complementary methods of diagnostic confirmation must be known in order to carry out the appropriate treatment

[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.

Spontan pneumomediastinum ovanlig orsak till akut bröstsmärta.

A previously healthy 21-year old man presented to the emergency department with sudden onset central chest pain exacerbated by breathing. A plain chest X-ray showed air within the mediastinum and pericardium confirmed by a CT scan with contrast. The patient history did not raise suspicion of any concomitant disease and the diagnosis of spontaneous pneumomediastinum with pneumopericardium was made. The patient recovered completely over the next few days with bed rest and analgesics. Spontaneous pneumomediastinum is an uncommon disease caused by rupture of perivascular alveoli causing air leakage to the mediastinum. The condition is benign and self-resolving in most cases. Pneumopericardium, a rare complication to spontaneous pneumomediastinum, is also usually self-resolving but may cause cardiac tamponade requiring intervention. Spontaneous pneumomediastinum must be differentiated from secondary pneumomediastinum caused by an underlying condition, such as esofageal rupture, trauma or infection, which may require specific treatment.

Neumopericardio en el transcurso de una miomectomía laparoscópica / Neumopericardium in the course of laparoscopic myomectomy

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Neumopericardio en un paciente con carcinoma de pulmón / Pneumopericardium in a patient with lung carcinoma

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Anorexia nervosa with massive pulmonary air leak and extraordinary propagation.

A rare case combining pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, pneumorrhachis, air in retroperitoneum and extensive subcutaneous emphysema simultaneously in a severely anorectic male with BMI 9.2 (22.8 kg) and multiple vomitings is presented. This unusual condition was treated successfully with conservative medical approach in a specialized somatic unit for anorexia nervosa.

Neumopericardio en paciente con rotura traqueal tras politraumatismo por accidente de tráfico / Pneumopericardium in a patient with tracheal rupture after multiple injuries from a traffic accident

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