RESUMO
A 79-year-old male with severe aortic stenosis was admitted with syncope and cranioencephalic traumatism with major nasal hemorrhage. While being prepared for surgical aortic valve replacement, a high-degree atrioventricular block was detected and a definite pacemaker was implanted.
Assuntos
Estenose da Valva Aórtica , Bloqueio Atrioventricular , Marca-Passo Artificial , Pneumopericárdio , Substituição da Valva Aórtica Transcateter , Masculino , Humanos , Idoso , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia , Pneumopericárdio/terapia , Tratamento Conservador , Valva Aórtica/cirurgia , Marca-Passo Artificial/efeitos adversos , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Resultado do TratamentoRESUMO
A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and deep inspiration accompanied by dysphonia and odynophagia in the last 1 day. He had a notable history of viral fever with non-productive cough 2 weeks prior, which resolved spontaneously. Examination revealed stable haemodynamic parameters. Palpable non-tender crepitus was felt in left anterior chest wall, axilla and both sides of the neck. Auscultation revealed Hamman's sign. ECG showed high voltage complexes and 2-dimensional echocardiogram (2D ECHO) showed normal biventricular function. CXR was evident of subcutaneous emphysema, pneumopericardium and Naclerio's sign clinching the diagnosis of pneumomediastinum. CT findings were consistent with a diagnosis of Hamman's syndrome. Patient was admitted for observation and treated with high-flow oxygen. He improved symptomatically and was discharged on the fourth day of admission.
Assuntos
Enfisema Mediastínico , Pneumopericárdio , Enfisema Subcutâneo , Masculino , Adolescente , Humanos , Auscultação , Dispneia/diagnóstico , Pneumopericárdio/diagnóstico , Diagnóstico Diferencial , Síndrome , Enfisema Subcutâneo/diagnósticoRESUMO
A 66-year-old man with a history of gastric pull-up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X-ray demonstrated pneumopericardium. Computed tomography revealed ulceration and abscess in the gastric conduit adjacent to the heart, suggesting gastropericardial fistula. As the patient did not show tamponade physiology, he was conservatively treated with antibiotics. The pneumopericardium diminished; however, he developed effusive-constrictive pericarditis with overt heart failure symptoms. Because pericardiocentesis failed to relieve the symptoms, pericardiectomy was performed. Intraoperative exploration revealed remarkably thickened pericardium and epicardium constituting multiple layers with purulent effusion. Epicardiectomy as well as pericardiectomy were required to achieve the effective reduction of central venous pressure. Perforation of the gastric conduit into the pericardial cavity was identified and repaired. Histopathology demonstrated thickened pericardium composed of hyalinized stroma, collagenous bundles, and infiltration of inflammatory cells. Streptococcus anginosus and Candida tropicalis were identified by culture of the resected tissue.
Assuntos
Fístula , Derrame Pericárdico , Pericardite Constritiva , Pneumopericárdio , Idoso , Humanos , Masculino , Pericardiectomia , Pericardite Constritiva/complicações , Pericardite Constritiva/diagnóstico , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologiaRESUMO
Pneumopericardium is a rare complication of pericardiocentesis (PC), occurring as a result of either a direct pleuropericardial communication or a leaky drainage system. Pneumopericardium is often self-limiting; however, physicians should be aware of this complication as it may progress to tension pneumopericardium, which requires immediate recognition and management. PC has been associated with pneumothorax, pneumomediastinum or subcutaneous emphysema, but the association with pleural effusion has been less reported. The authors present the case of a 14-year-old healthy boy who developed post-PC pneumopericardium and pleural effusion, a rare association reported in the literature. The diagnosis of this potential life-threatening event was made using readily available complementary diagnostic methods, such as transthoracic echocardiography and chest X-ray.
Assuntos
Pericardiocentese/efeitos adversos , Derrame Pleural/etiologia , Pneumopericárdio/etiologia , Complicações Pós-Operatórias , Adolescente , Ecocardiografia , Exsudatos e Transudatos , Humanos , Masculino , Derrame Pleural/diagnóstico , Pneumopericárdio/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Pneumopericárdio/etiologia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumopericárdio/diagnóstico , Pneumotórax/diagnóstico , Pneumotórax/terapia , Radiografia Torácica , SARS-CoV-2 , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Lesões Acidentais/complicações , Fraturas Múltiplas/diagnóstico , Laparoscopia , Pneumopericárdio/diagnóstico , Traumatismos Abdominais/diagnóstico , Fraturas do Quadril/diagnóstico , Humanos , Masculino , Motocicletas , Pneumopericárdio/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemAssuntos
Carcinoma de Células Escamosas/patologia , Quimiorradioterapia , Dor no Peito/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Pneumopericárdio/diagnóstico , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Dor no Peito/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pneumopericárdio/etiologia , Pneumopericárdio/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Tomografia Computadorizada por Raios X , Recusa do Paciente ao Tratamento , UltrassonografiaAssuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fístula Esofágica/etiologia , Pneumotórax/etiologia , Idoso , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Fístula Esofágica/diagnóstico , Evolução Fatal , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/etiologia , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia , Pneumotórax/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologiaRESUMO
We report an uncommon case of ventricular assist device-related infection and resultant fistula formation into the gastrointestinal tract. A 69-year-old man, who had undergone implantation of a HeartMate II 1 year earlier secondary to ischemic cardiomyopathy, presented to our hospital with a high fever. Computed tomography showed unusual gas collection around the heart apex (i.e., pneumopericardium), which had not been detected before. The patient developed sudden melena with fresh blood without abdominal symptoms 1 month after beginning antibiotic therapy. Emergent colonoscopy showed that the HeartMate II strain relief of the inflow conduit had penetrated the transverse colon. We immediately performed laparoscopy-assisted left-sided hemicolectomy and found intraoperatively that a fistula had formed between the splenic flexure and the pericardial cavity. Subsequently, the HeartMate II system was totally explanted and replaced with an Impella 5.0 for alternative hemodynamic support. In our patient, pneumopericardium might have been an early sign of a hidden gastrointestinal complication. Our experience is a caution for clinicians who manage patients with ventricular assist device support via the apex.
Assuntos
Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Fístula Intestinal/etiologia , Pneumopericárdio/etiologia , Idoso , Hemodinâmica , Humanos , Fístula Intestinal/diagnóstico , Masculino , Pneumopericárdio/diagnósticoAssuntos
Tamponamento Cardíaco/etiologia , Unidades de Terapia Intensiva , Pneumopericárdio/diagnóstico , Respiração Artificial/efeitos adversos , Traqueostomia/efeitos adversos , Tamponamento Cardíaco/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumopericárdio/complicações , Radiografia TorácicaRESUMO
A term infant with cardiorespiratory failure treated with veno-venous extracorporeal membrane oxygenation developed pneumopericardium with cardiac tamponade while on the extracorporeal membrane oxygenation circuit. The patient was converted to veno-arterial extracorporeal membrane oxygenation and managed conservatively with spontaneous resolution of the air leak.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Pneumopericárdio/diagnóstico , Humanos , Recém-Nascido , Masculino , Pneumopericárdio/patologiaRESUMO
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.
Assuntos
Tamponamento Cardíaco/etiologia , Drenagem/métodos , Pneumopericárdio , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/mortalidade , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Masculino , Pneumopericárdio/complicações , Pneumopericárdio/diagnóstico , Pneumopericárdio/mortalidade , Respiração Artificial , Taxa de Sobrevida/tendênciasAssuntos
Fístula Brônquica/complicações , Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Pericárdio/diagnóstico por imagem , Pneumopericárdio/etiologia , Fístula Brônquica/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumopericárdio/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Esophagopericardial fistulas are rare. Most reported cases are related to malignancy or prior surgical intervention. We report a case of an esophagopericardial fistula presenting as pneumopericardium and purulent pericarditis in a patient with a history of caustic ingestion and an esophageal stent.
Assuntos
Queimaduras Químicas/complicações , Cáusticos/efeitos adversos , Fístula Esofágica/complicações , Esôfago/lesões , Fístula/complicações , Pneumopericárdio/etiologia , Stents/efeitos adversos , Adulto , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/cirurgia , Fístula Esofágica/diagnóstico , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Fístula/diagnóstico , Humanos , Masculino , Pericárdio/diagnóstico por imagem , Pneumopericárdio/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios XAssuntos
Anuloplastia da Valva Cardíaca , Complicações Intraoperatórias/diagnóstico por imagem , Valva Mitral , Pneumopericárdio , Pneumoperitônio , Deiscência da Ferida Operatória , Tomografia Computadorizada por Raios X/métodos , Cavidade Abdominal/diagnóstico por imagem , Anuloplastia da Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Cardíaca/métodos , Endocardite/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Valva Mitral/cirurgia , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia , Pneumopericárdio/fisiopatologia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/etiologia , Técnicas de Fechamento de Ferimentos/efeitos adversosAssuntos
Broncoscopia/métodos , Pneumonectomia/efeitos adversos , Pneumopericárdio/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pneumopericárdio/etiologia , Pneumopericárdio/cirurgia , Reoperação , Índice de Gravidade de Doença , Toracotomia/métodosRESUMO
Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.