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Pneumopericardium


Presentation

  • The aim of this study was to document the mode of presentation and to suggest a protocol for management.[ncbi.nlm.nih.gov]
  • We are presenting a case of a patient who presented 5 days after PPM insertion with new-onset pleuritic chest pain. She had a normal chest X-ray (CXR), and acceptable pacing checks.[ncbi.nlm.nih.gov]
  • The following case is the first ever report of plastic bronchitis presenting with pneumopericardium. CASE REPORT A 24-year-old female presented to our Emergency Department with an asthma exacerbation.[ncbi.nlm.nih.gov]
  • Here we present a case of a young man who presented to the emergency department with acute shortness of breath following a motor vehicle accident.[ncbi.nlm.nih.gov]
  • We present a rare case of tension pneumopericardium with cardiogenic shock due to bronchopericardial fistula in a patient with bronchogenic carcinoma who was successfully treated with transpericardial intervention.[ncbi.nlm.nih.gov]
Large Pericardial Effusion
  • The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device.[ncbi.nlm.nih.gov]
  • He was referred from a local hospital for pericardiocentesis and further work-up due to a large pericardial effusion.[jkms.org]
Pericardial Friction Rub
  • In addition to ECG changes, other findings include dyspnoea, pericardial friction rub, pulmonary rales and an elevated central venous pressure.[jmedicalcasereports.com]
Retrosternal Chest Pain
  • He continued to play, but 2 hours later, he developed sharp retrosternal chest pain. A chest radiograph and an echocardiograph at the nearest emergency department showed pneumopericardium and pneumomediastinum.[ncbi.nlm.nih.gov]
Retrosternal Chest Pain
  • He continued to play, but 2 hours later, he developed sharp retrosternal chest pain. A chest radiograph and an echocardiograph at the nearest emergency department showed pneumopericardium and pneumomediastinum.[ncbi.nlm.nih.gov]
Ulcer
  • Esophagoscopy revealed a deep esophageal ulcer 4.5 cm in diameter, 36 cm from the incisors; the pericardial cavity and the lining of the columnar epithelium could be directly visualized to the distal 10 cm of the esophagus.[dx.doi.org]
  • […] structure e.g. pleural space, pulmonary substance, bronchial tree, gastrointestinal tract examples include staphylococcal lung abscess rupture erosion into the pericardium as a result of a bronchial carcinoma gastropericardial fistula complicating peptic ulcer[gpnotebook.co.uk]
  • Trauma, infections, ulcers, and esophageal diseases are well described causes of pericardial air but rarely lead to cardiovascular compromise.[journals.lww.com]
Suggestibility
  • Bright spots were seen rapidly moving along the pericardial layer during diastole with comet-tail artifacts extending across the whole image of the heart and disappearing during systole, suggesting pneumopericardium.[ncbi.nlm.nih.gov]
  • These findings suggested traumatic pericardial rupture without cardiac herniation. After chest drainage, a follow-up CT scan demonstrated no pericardial or pleural air.[ncbi.nlm.nih.gov]
  • This case suggests that computed tomography is a sensitive modality to confirm the diagnosis at the early stage of this complication.[ncbi.nlm.nih.gov]
  • The aim of this study was to document the mode of presentation and to suggest a protocol for management.[ncbi.nlm.nih.gov]
  • This experience and review of other authors' observations suggest that prompt drainage by catheter and continuous suction is indicated. ( Am J Dis Child 130:393-396, 1976)[jamanetwork.com]
Neglect
  • Advice for timely review was again neglected, except for a visit after roughly a month for a new attack of respiratory tract infection.[laryngologyandvoice.org]

Workup

Pneumothorax on Chest X-Ray
  • Twenty days after the procedure, the patient complained of shortness of breath and was found to have a 30 % apical left pneumothorax on chest X-ray as a not unusual complication of the subclavian venous access.[ncbi.nlm.nih.gov]
Normal Chest X-Ray
  • She had a normal chest X-ray (CXR), and acceptable pacing checks. However, a CT scan of the chest showed pneumopericardium and pneumothorax secondary to atrial lead perforation. The pain only settled by replacing the atrial lead.[ncbi.nlm.nih.gov]
Premature Atrial Contractions
  • These findings may be non-specific ST-segment or T-wave changes, axis deviation and dysrhythmias, such as premature atrial contractions, bundle branch blocks and ventricular fibrillation [ 1 ].[jmedicalcasereports.com]
T Wave Inversion

Treatment

  • After treatment with antibiotics and analgesics, the patient recovered without any complications.[ncbi.nlm.nih.gov]
  • Treatment options are limited. We present a rare case of tension pneumopericardium with cardiogenic shock due to bronchopericardial fistula in a patient with bronchogenic carcinoma who was successfully treated with transpericardial intervention.[ncbi.nlm.nih.gov]
  • The underlying etiology should be sought so that treatment can be expedited. Pneumopericardium may result from traumatic and nontraumatic etiologies.[ncbi.nlm.nih.gov]
  • He required transfer to an advanced emergency medical service center for treatment. Although he was hemodynamically stable then, the patient's condition deteriorated during transportation.[ncbi.nlm.nih.gov]
  • Without treatment, survival is measured in months. We report a case of a 51-year-old male patient with pneumopericardium as a complication of intestinal T/NK cell lymphoma.[ncbi.nlm.nih.gov]

Prognosis

  • T/NK cell lymphomas show aggressive and invasive clinical progression, with a poor prognosis. Without treatment, survival is measured in months.[ncbi.nlm.nih.gov]
  • Treatment and prognosis Complications cardiac tamponade A pneumopericardium can usually be distinguished from pneumomediastinum , since gas in the pericardial sac should not rise above the anatomic limits of the pericardial reflection on the proximal[radiopaedia.org]
  • […] absence of tension then, in general, treatment is aimed at the specific cause if signs of tamponade develop then urgent pericardiocentesis is required a pericardial catheter should be left in place in order to prevent the development of further tension Prognosis[gpnotebook.co.uk]
  • Without prompt evacuation of the pericardial air, prognosis is poor.[journals.lww.com]

Etiology

  • The underlying etiology should be sought so that treatment can be expedited. Pneumopericardium may result from traumatic and nontraumatic etiologies.[ncbi.nlm.nih.gov]
  • Contributing factors and possible etiologies are discussed.[ncbi.nlm.nih.gov]
  • Of these 21 patients with simultaneous pneumomediastinum, eight patients had associated pneumopericardium; five patients with pneumopericardium had blunt chest trauma as etiology and three patients had penetrating trauma as etiology for pneumopericardium[ijsronline.net]
  • Etiology Underlying causes include: positive pressure ventilation thoracic surgery/pericardial fluid drainage penetrating trauma blunt trauma (rare) infectious pericarditis with gas-producing organisms fistula between the pericardium and an adjacent air-containing[radiopaedia.org]
  • It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy.[thoracicmedicine.org]

Pathophysiology

  • Its radiographic appearance on anteroposterior films of the supine infant may be confused with pneumomediastinum or pneumothorax so that knowledge of the relevant fascial layers is necessary for an understanding of the pathophysiology and allows proper[pediatrics.aappublications.org]
  • The pathophysiology was demonstrated by Macklin in animal studies 4 ).[kjim.org]
  • A rise in the intra-alveolar pressure above atmospheric pressure is important in the pathophysiology of pneumopericardium and pneumomediastinum.[ijsronline.net]

Prevention

  • In most cases the air will resorb without active management but if a tension pneumopericardium develops urgent drainage is required to prevent cardiovascular compromise and death.[degruyter.com]
  • Cardiac tamponade was prevented by timely aspiration of the pericardial effusion.[austinpublishinggroup.com]
  • Management: Seek expert advice. in the absence of tension then, in general, treatment is aimed at the specific cause if signs of tamponade develop then urgent pericardiocentesis is required a pericardial catheter should be left in place in order to prevent[gpnotebook.co.uk]
  • Fracture of tracheostomy tubes-pathogenesis and prevention. J Laryngol Otol 1983;97:771-4. [ PUBMED ] 3. Kohli GS, Yadav SP, Sharma RC, Raj B, Chawla RK. Tracheostomy tubes-presenting as foreign bodies in the tracheobronchial tree.[laryngologyandvoice.org]
  • References Jeng MJ, Lee YS, Tsao PC, Soong WJ (2012) Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc 75: 551-559.[omicsonline.org]

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