Low-voltage electrocardiogram in a comatose patient after endoscopic retrograde cholangiopancreatography

A 59-year-old female became comateuse after endocscopic retrograde cholangiopancreatography, and developed low-voltage ECG. Computed tomography revealed air emboli in the brain, the intestinal veins and in the pericardium. Low-voltage ECG most probably was due to pneumopericardium.

Gastropericardial fistula and Candida albicans pericarditis: a rare complication of gastric adenocarcinoma treated with radiation and chemotherapy

Gastropericardial fistula is generally associated with benign gastric diseases and is an uncommon complication of gastric adenocarcinoma. Pericarditis and cardiac tamponade are the ultimate outcome, with extremely high mortality rates. We report a 47-year-old man with gastric adenocarcinoma who had completed radiotherapy and was on scheduled chemotherapy, who presented with fever and chest pain. Gastric adenocarcinoma complicated with gastropericardial fistula and Candida albicans pericarditis were diagnosed and treated successfully with conservative management. Initial chest radiography and computed tomography (CT) revealed no evident pericardial air or fluid. However, follow-up panendoscopy 2 weeks later revealed a malignant ulcer with a fistula opening over the lesser curvature of the high body of the stomach. Subsequent chest radiography and CT revealed pneumopericardium with fluid accumulation. Emergent CT-guided pericardial drainage was performed. The fluid was positive for Candida albicans. Total parenteral nutrition and antifungal therapy were administered. The patient refused surgical intervention and survived with medical management alone. This case demonstrates that first, panendoscopy may be safely performed in patients with gastropericardial fistula without significant risk of cardiac tamponade; second, although early diagnosis of gastropericardial fistula is generally important, delayed recognition may not lead to devastating outcomes even in the absence of surgical intervention.

[Clinical case of the month. Spontaneous pneumopericardium after sternal dehiscence]

We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with the bronchial tree or oesophagus and intrapericardial gazeous production due to bacterial pericarditis. Pericardiocentesis is indicated in case of air tamponade and local infection.

Tension pneumopericardium after removal of pericardiocentesis drainage catheter

This image showed tension pneumopericardium caused by removing the pericardiocentesis catheter, which was inserted to drain malignant pericardial effusion. Tension pneumopericardium is a rare and potentially fatal event. Mortality from tension pneumopericardium can be as high as 50%. Therefore, it is important to suspect and detect early, if the patient complained of dyspnea after removing the pericardiocentesis drainage catheter.

Hydropneumopericardium presenting as an acute coronary syndrome: a rare complication of paraesophageal hernia

Hydropneumopericardium is a very rare complication of long-standing paraesophageal hernia, occurring as a result of rupture of the intrathoracic gastric volvulus into the pericardium. A chronic paraesophageal hernia that is complicated by gastric volvulus can develop into such surgical emergencies as acute gastric obstruction, strangulation, perforation, and rupture into adjacent structures. Subsequent hydropneumopericardium constitutes an acute emergency that requires immediate surgical treatment and pericardial drainage. Herein, we discuss what we believe to be the 1st reported case of hydropneumopericardium that presented as an acute coronary syndrome in a patient who had a chronic paraesophageal hernia (as a result of rupture of the gastric volvulus into the pericardium). The 80-year-old patient did not survive the condition.

Pneumopericardium after blunt chest trauma: Mechanical ventilation with positive pressure must be avoided

A 38-year-old polytraumatized man was admitted with signs of cardiogenic shock (low blood pressure, tachycardia, tachypnea, and elevated central venous pressure). A near tension pneumopericardium was revealed by thorax CT. Air from the pericardial sac remissed 4 days later conservatively, avoiding invasive or non-invasive mechanical ventilation. The use of positive-pressure ventilation, with or without intubation, would probably lead to tension pneumopericardium-cardiac tamponade, needing emergent decompression.

[Pneumopericardium caused by gastropericardial fistula]

This is the case of a 56-year-old male who presented at our Emergency Room complaining of severe epigastric pain that radiated towards the left shoulder and neck. Pneumopericardium was diagnosed with plain chest X-rays, which indicated a gastropericardial fistula. A contrast X-ray film was taken using a water-soluble contrast. A full gastrectomy was performed with esophagojejunostomy reconstruction and pericardial drainage, which resulted in a favourable patient outcome.

Pneumopericardium and pneumomediastinum in a passenger on a commercial flight

Pneumopericardium and pneumomediastinum are rare presentations seen most commonly in the context of chest trauma or mechanical ventilation. Here we present a case of a spontaneous pneumopericardium and pneumomediastinum, which occurred in a young man with a recent coryzal illness and multiple Valsalva maneuvers in flight. Although the etiology of pneumopericardium and pneumomediastinum are well described in the literature, possible acute risks to flight personnel have not been previously documented.

Arterielle Luftembolie nach Polytraumatisierung bei Sturz aus dem 10. Stock

We report about the case of a 20-year-old patient who fell from the tenth floor. The patient suffered multiple injuries and systemic gas embolism. He survived his injuries despite CPR, massive transfusion, development of ARDS and SIRS with minimal neurological deficit. The possible pathogenesis of the systemic gas embolism as well as the therapy are discussed. Besides stabilizing the circulation with i.v. fluids, blood transfusion and catecholamine therapy, the use of hyperbaric oxygenation was the decisive therapeutic measure.

Pneumothorax and tension pneumopericardium following cardiothoracic surgery

Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.

Pneumopericardium: A rare complication of laparoscopic varicocoele ligation

Although symptomatic pneumopericardium post-laparoscopic varicocoele ligation procedure is rare, numerous cases have been reported and identified pneumopericardium as a complication of laparoscopic surgery. Pneumopericardium after other urological procedures has been previously reported when diagnosed incidentally on chest X-ray but there are no reports of symptomatic presentation. We hereby present the first symptomatic pneumopericardium case after a routine procedure for the ligation of varicocoele.

The Macklin effect--pneumomediastinum and pneumopericardium following blunt chest trauma

Pneumomediastinum and pneumopericardium following blunt chest trauma are rare. Diagnosis is by chest radiograph and CT Scan. They have to be identified and treated accordingly. Usually, pneumomediastinum and pneumopericardium are self-limiting requiring no specific therapy. However, vigilance and a continuous monitoring of the vital signs are necessary.

Spontaneous pneumopericardium, pneumomediastinum and subcutaneous emphysema: unusual complications of asthma in a 2-year-old boy

A 2-year-old boy presented to the emergency department with a history of sudden onset of cough, dyspnoea and a slight expiratory wheeze on the right lung base. He also had subcutaneous emphysema on the left side of the chest anteriorly. Chest x ray confirmed subcutaneous emphysema and also revealed pneumomediastinum and pneumopericardium. He had had no previous episode and was not known to have asthma. He was apyrexial but had a raised white cell count. The eosinophil count was within normal limits. He was successfully treated with nebulised salbutamol, steroids, antibiotics and high flow oxygen. He made a good recovery and was discharged after 7 days. This case highlights the need for a high index of suspicion of asthma in very young children presenting for the first time with such complications.