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1.
J Card Surg ; 34(9): 829-836, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31269314

RESUMO

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/tendências
3.
4.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

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.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
10.
Mil Med ; 183(3-4): e81-e88, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29514336

RESUMO

Introduction: Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF. Materials and Methods: The assessment of radiologic findings in patients who suffer from combat-related thoracic trauma is the basis of this review article. The imaging modalities for this study include multi-detector computed tomography and chest radiography. Results: High-velocity penetrating projectile injuries appear as hemorrhage and re-expansion pulmonary edema from the temporary cavity and a linear, blood-filled track from the permanent cavity. In cases where the projectile passes totally through the body, entrance wounds at the skin surface and tracks through the subcutaneous tissues may be the only indications of penetrating trauma. When assessing vascular injury, special attention should be paid to the right hilum in contrast-enhanced multi-detector computed tomography, as contrast is concentrated in the superior vena cava and superior cavoatrial junction may obscure small fragments. Additionally, CT angiography may show vessel disruption or extravasation of contrast distal to normal vessel location in addition to intraluminal filling defects and pseudo-aneurysms. Tension pneumopericardium may rarely complicate penetrating or blunt chest trauma. On imaging, distension of the pericardial sack by pneumopericardium and compression of the heart support the diagnosis of tension. On multi-detector computed tomography in the acute trauma setting, fluid in the pleural space should be considered hemothorax, particularly when Hounsfield units are above 35. Acutely, extravasated blood will have similar attenuation to the thoracic vasculature, whereas clotted blood will have higher values of 50-90 Hounsfield units. Conclusion: Combat-related thoracic trauma continues to be a significant contributor to the morbidity and mortality of those injured during OEF and OIF. This review of the imaging manifestations of penetrating thoracic injury during OEF and OIF focuses on key diagnostic findings for clinicians caring for combat casualties. The distinct injury pattern and atypical imaging manifestations of penetrating trauma are important to recognize early due to the acuity of this patient population and the influence of accurate diagnosis on clinical management.


Assuntos
Diagnóstico por Imagem/métodos , Traumatismo Múltiplo/diagnóstico , Ferimentos Penetrantes/diagnóstico , Adulto , Diagnóstico por Imagem/tendências , Feminino , Hemotórax/diagnóstico , Hemotórax/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/tendências , Pneumopericárdio/diagnóstico , Pneumopericárdio/diagnóstico por imagem , Pneumotórax/diagnóstico , Pneumotórax/diagnóstico por imagem , Radiografia/métodos , Ferimentos Penetrantes/diagnóstico por imagem
13.
Transpl Infect Dis ; 20(1)2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29105898

RESUMO

A 60-year-old woman with a history of dilated cardiomyopathy underwent heart transplantation. One month post discharge, she presented to clinic with low-grade fever and productive cough. Her chest radiograph showed air-fluid levels in the pericardial silhouette. Transthoracic echocardiogram showed a large complex pericardial collection with no evidence of cardiac tamponade. The patient was urgently taken to the operating room for exploration. A large "egg-shaped" mass in the pericardium measuring 10 × 12 cm with gaseous material was aspirated. As the posterior wall of the mass was firmly adhered to the right atrium, the capsule was incompletely excised. We present the case of a potentially life-threatening complication post transplantation that required surgical debridement and life-long antibiotic suppressive therapy. To our knowledge, this is the first report of purulent pericardial collection caused by Enterobacter cancerogenous. Further research is required to better understand the biology of this microorganism and the role it may play as a pathogen in immunocompromised patients following solid organ transplantation.


Assuntos
Infecções por Enterobacteriaceae/microbiologia , Transplante de Coração/efeitos adversos , Pericardite/microbiologia , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia , Ecocardiografia , Enterobacter/isolamento & purificação , Enterobacter/patogenicidade , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/tratamento farmacológico , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Pericardite/diagnóstico , Pericardite/diagnóstico por imagem , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/microbiologia
14.
Neonatal Netw ; 36(6): 368-373, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29185948

RESUMO

Pneumopericardium occurs when air accumulates in the pericardial sac surrounding the heart and is one of the rarest forms of air leaks in neonates. Because of various advances in neonatal care, including gentler modes of ventilation, surfactant replacement, and antenatal steroids, the incidence of pneumopericardium has decreased. Despite the decrease in incidence of pneumopericardium, most cases arise in premature infants with a history of respiratory distress and mechanical ventilation. Evidence has shown that the incidence is inversely related to birth weight and that pneumopericardium has high mortality and morbidity rates.


Assuntos
Barotrauma , Pneumopericárdio , Radiografia Torácica/métodos , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido , Barotrauma/diagnóstico , Barotrauma/etiologia , Barotrauma/fisiopatologia , Hemodinâmica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/métodos , Masculino , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia , Pneumopericárdio/fisiopatologia , Pneumopericárdio/terapia , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/terapia , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Suspensão de Tratamento
15.
J S Afr Vet Assoc ; 88(0): e1-e5, 2017 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-28582985

RESUMO

A 5-year-old, intact, male Yorkshire Terrier presented with a 6-day history of lethargy and anorexia. Clinical examination revealed dental plaque accumulation, abdominal effort during respiration and muffled heart sounds. Thoracic radiographs revealed an enlarged globoid cardiac silhouette and mild pneumopericardium, transthoracic ultrasonography revealed a pericardial effusion after which pericardiocentesis, cytology and culture diagnosed septic pericarditis. Three multidrug-resistant bacteria were isolated, two of which have been implicated in gas-producing infections before. Medical management failed to resolve the pericarditis and euthanasia was opted for. A chronic osseocartilaginous oesophageal foreign body cranial to the heart base was found on necropsy. Septic pericarditis and pneumopericardium are rare conditions in dogs. This is the first case to describe a multidrug-resistant polybacterial aetiology causing mild pneumopericardium and only the second case to describe septic pericarditis associated with an oesophageal foreign body.


Assuntos
Doenças do Cão/diagnóstico , Corpos Estranhos/veterinária , Pericardite/veterinária , Pneumopericárdio/veterinária , Animais , Cães , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/veterinária , Pericardite/diagnóstico , Pericardite/etiologia , Pneumopericárdio/diagnóstico , Pneumopericárdio/etiologia
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