Early cardiac tamponade due to tension pneumopericardium after bilateral lung transplantation

Early postoperative complications in lung transplant recipients

Lung transplantation has become an established therapy for end-stage lung diseases. Early postoperative complications can impact immediate, mid-term, and long-term outcomes. Appropriate management, prevention, and early detection of these early postoperative complications can improve the overall transplant course. In this review, we highlight the incidence, detection, and management of these early postoperative complications in lung transplant recipients.

Acute Delayed Tension Pneumopericardium: The First Reported Case After Elective Lobectomy

Pneumopericardium is an overall rare condition caused by increased intrathoracic positive pressure. Different mechanisms can contribute to its development. It can be observed in both pediatric and adult populations. Only a small percentage of patients have cardiac tamponade. We describe the first case of delayed tension pneumopericardium after elective lobectomy. Sudden symptom onset and clinical management are discussed. Only an accurate and quick patient assessment allowed diagnosing this condition and, hence, its correct treatment. Although the diagnosis of pneumopericardium is uncommon, if untreated, it can be fatal.

Esophagopericardial fistula, septic shock and intracranial hemorrhage with hydrocephalus after lung transplantation

A 57-year old woman underwent lung transplantation for non-specific interstitial pneumonia. Primary graft dysfunction was diagnosed requiring continued use of extracorporeal membrane oxygenation (ECMO). Within three days she developed recurring hemothoraces requiring two surgical evacuations. After ECMO removal a series of complications occurred within four months: femoral thrombosis, persisting tachycardic atrial fibrillation, pneumopericardium with an esophagopericardial fistula and purulent pericarditis, septic shock, multiorgan failure and intracerebral hemorrhage with ventricular involvement requiring external ventricular drainage. Interdisciplinary management coordinated by the intensive care specialist, transplant surgeon and pulmonologist with various interventions by the respective specialists followed by intensive physical rehabilitation allowed for discharge home on day 235 post transplant. Subsequently quality of life was considered good by the patient and family.

Pneumopericardium diagnosis by point-of-care ultrasonography

Focused cardiac ultrasound by the emergency physician has become a fundamental tool to expedite the diagnostic evaluation of the patient at bedside. We report the case of a patient admitted to the emergency department for respiratory distress. He was examined by an emergency physician who performed a bedside echocardiography. 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.

Intraoperative occurrence of a pneumopericardium during double-lung transplantation

Pneumopericardium is rare and has been reported secondary to chest trauma. We report a case of tension pneumopericardium occurring during double-lung transplantation, where intraoperative transoesophageal echocardiography first showed a hypokinetic left ventricle and a few minutes later a compression of its anterolateral portion due to pneumopericardium. Although the pericardium was opened, left ventricular function remained depressed, necessitating extracorporeal membrane oxygenation, which was withdrawn after 48 h of assistance when left ventricular function had recovered. The patient was extubated on the seventh postoperative day but died of multiorgan failure on the 64 th postoperative day.

Cardiac tamponade secondary to pneumopericardium after lung transplantation: a case report

Pneumopericardium is a rare cause of cardiac tamponade. It is an exceptional complication of lung transplantation. We have presented a case of a patient with cystic fibrosis who experienced cardiac tamponade secondary to a tension pneumopericardium during the postoperative course after lung transplantation. Dehiscence of the bronchial suture line was confirmed by fiberoptic bronchoscopy.

Management of the patient undergoing lung transplantation: an intensive care perspective

The postoperative management of a patient undergoing lung transplantation involves many components of care. These components include ventilatory and hemodynamic management, immunosuppression, wound care, rehabilitation, infection control and treatment, and early detection of rejection.