Pneumopericardium

Background

  • Air in the pericardium
  • Generally secondary to connection between pericardium and pleural cavity, bronchi, or GI tract
  • Most often found following trauma, severe asthma exacerbation, strangulation, or forceful drug insufflation

Causes of pneumopericardium

Clinical Features

  • May present with tamponade physiology depending on size
  • Other features include:
    • Dyspnea
    • Cyanosis
    • Chest pain
    • Pulsus paradoxus
    • Bradycardia
    • Tachycardia
    • May have subcutaneous emphysema
    • May have succussion splash if there is also a pericardial effusion
    • May have Hamman crunch

Differential Diagnosis

Thoracic Trauma

Evaluation

  • Assess for underlying cause
  • CXR[1]
    • Heart partially or completely surrounded by gas
    • Pericardium sharply outlined by gas density on either side
    • Continuous diaphragm sign may be present (diaphragm seen continuously across the midline
  • PoCUS[2]
    • Bright spots moving along pericardial layer during diastole
    • Comet-tail artefacts extending across heart and disappearing during systole

Management

  • Treat underlying cause
  • Conservative management usually sufficient (usually self-resolves)
  • If tamponade physiology, may require pericardiocentesis
    • If communicating pneumothorax, chest tube placement may resolve both[3]

Disposition

  • If underlying cause is stable and patient is asymptomatic, may discharge home
  • Most patients will require admission for treatment of underlying cause

See Also

References

  1. Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.
  2. Bobbia et al. (2013). Pneumopericardium diagnosis by point-of-care ultrasonography. Journal of Clinical Ultrasound, 4(14), May 2013.
  3. Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).
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