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Sciarretta JD, Noorbakhsh S, Joung Y, Bailey DW, Freedberg M, Nguyen J, Smith RN, Ayoung-Chee P, Davis MA, Benjamin ER, Todd SR. Pneumopericardium following severe thoracic trauma. Injury 2024; 55:111303. [PMID: 38218676 PMCID: PMC11023791 DOI: 10.1016/j.injury.2023.111303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/24/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a pneumothorax, interstitial air tracking along the pulmonary perivascular sheaths from ruptured alveoli to the pericardium, or direct trachea-bronchial-pericardial communication. Our objectives were to describe the modern management approach to PPC and to identify variables that could improve survival with severe thoracic injury. METHODS We conducted a retrospective study of the trauma registry between 2015 and 2022 at a Level I verified adult trauma center for all patients with PPC. Demographics, injury patterns, and treatment characteristics were compared between blunt and penetrating trauma. This study focused on the management strategies and the physiologic status regarding PPC and the development of tension physiology. The main outcome measure was operative versus nonoperative management. RESULTS Over a seven-year period, there were 46,389 trauma admissions, of which 488 patients had pneumomediastinum. Eighteen patients were identified with PPC at admission. Median age was 39.5 years (range, 18-77 years), predominantly male (n = 16, 89 %), Black (n = 12, 67 %), and the majority from blunt trauma (78 %). Half had subcutaneous emphysema on presentation while 39 % had recognizable pneumomediastinum on chest x-ray. Tube thoracostomy was the most common intervention in this cohort (89 %). Despite tube thoracostomy, tension PPC was observed in three patients, two mandating emergent pericardial windows for progression to tension physiology, and the remaining requiring reconstruction of a blunt tracheal disruption. The majority of PPC patients recovered with expectant management (83 %), and no deaths were directly related to PPC. CONCLUSIONS Traumatic PPC is a rare radiographic finding with the majority successfully managed conservatively in a monitored ICU setting. These patients often have severe thoracic injury with concomitant injuries requiring thoracostomy alone; however, emergent surgical intervention may be required when PPC progresses to tension physiology to improve overall survival.
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Affiliation(s)
- Jason D Sciarretta
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US.
| | - Yoo Joung
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US
| | - Daniel W Bailey
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Mari Freedberg
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Jonathan Nguyen
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Randi N Smith
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Patricia Ayoung-Chee
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Millard A Davis
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Elizabeth R Benjamin
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - S Rob Todd
- Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
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López-Figueroa C, Domingo M, Duignan PJ, Cuvertoret-Sanz M, Martí-García B, Pintado E, Martinez M, Martínez J. Air leak syndrome in animals: definition and pathogenesis. J Comp Pathol 2024; 211:42-51. [PMID: 38776614 DOI: 10.1016/j.jcpa.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/04/2023] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes.
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Affiliation(s)
- Carlos López-Figueroa
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Centre de Recerca en Sanitat Animal, UAB-IRTA, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Mariano Domingo
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Centre de Recerca en Sanitat Animal, UAB-IRTA, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Padraig J Duignan
- The Marine Mammal Center, 2000 Bunker Road, Sausalito, California, 94965, USA
| | - Maria Cuvertoret-Sanz
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Bernat Martí-García
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Ester Pintado
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Maggie Martinez
- The Marine Mammal Center, 2000 Bunker Road, Sausalito, California, 94965, USA
| | - Jorge Martínez
- Servei de Diagnòstic de Patologia Veterinària, Departament de Sanitat i Anatomia Animals, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Centre de Recerca en Sanitat Animal, UAB-IRTA, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
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3
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Gorman G, Morgan M, Schindler B. Pneumopericardium: A Rare Complication of Marginal Ulcers. J Emerg Med 2024; 66:235-236. [PMID: 38242752 DOI: 10.1016/j.jemermed.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Graci Gorman
- HealthPartners Institute, Regions Hospital, St. Paul, Minnesota.
| | - Matt Morgan
- HealthPartners Institute, Regions Hospital, St. Paul, Minnesota
| | - Broc Schindler
- HealthPartners Institute, Regions Hospital, St. Paul, Minnesota
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Ibrahim AO, Jaber F, Alghizzawi M, Metzinger M, Asif T. CT-Guided Pericardiocentesis in a Case of Tension Pneumopericardium and Tamponade Secondary to an Enteropericardial Fistula. JACC Case Rep 2023; 18:101909. [PMID: 37545683 PMCID: PMC10401056 DOI: 10.1016/j.jaccas.2023.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023]
Abstract
Tension pneumopericardium is most commonly traumatic. Nontraumatic etiologies are rare, but have been reported with gastropericardial and esophagopericardial fistulas. We present the case of a 54-year-old patient who developed a tension pneumopericardium with tamponade secondary to a perforated marginal ulcer in the proximal jejunum with an enteropericardial fistula. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ali O. Ibrahim
- Address for correspondence: Dr Ali O. Ibrahim, Department of Medicine, UMKC School of Medicine, 2411 Holmes Street, Kansas City, Missouri 64108, USA. @Ali_O_Ibrahim
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Zethof S, Borstlap C, Vroomans M, Groenendijk M. Pneumomediastinum complicating diabetic ketoacidosis. BMJ Case Rep 2023; 16:e255018. [PMID: 37137549 PMCID: PMC10163478 DOI: 10.1136/bcr-2023-255018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Pneumomediastinum is an uncommon finding in patients with diabetic ketoacidosis (DKA) and may occur spontaneously or secondary to an effort rupture of the oesophagus. Excluding oesophageal rupture is important, as delaying treatment increases the risk of mortality. We discuss a case of DKA complicated by vomiting, pneumomediastinum, pneumopericardium and air in the epidural space. Instead of fluoroscopic oesophagography, chest CT was used to investigate oesophageal rupture. We present an overview of case reports and retrospective studies illustrating the utility of chest CT in the investigation of oesophageal rupture over fluoroscopic oesophagography.
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Affiliation(s)
- Siem Zethof
- Intensive Care, Alrijne Zorggroep, Leiderdorp, Netherlands
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6
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Pometlova J, Handlos P, Jecminkova R, Kitka M, Koscielnik P. Tension pneumopericardium in a polytrauma patient. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:91-94. [PMID: 34747414 DOI: 10.5507/bp.2021.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and blood pressure can lead to difficulties in the detection of arterial bleeding from associated injuries while the increased venous pressure can increase the rate of bleeding. CASE REPORT This is the case of a patient after a car accident, with bilateral serial fractures, bilateral pulmonary contusion, bilateral pneumothorax, emphysema of the neck and chest, pneumomediastinum and pneumopericardium, and other injuries. During treatment, the patient developed a gradually progressing hemodynamic instability, resulting in pulseless electrical activity. Further progression of the case is detailed in the paper. CONCLUSIONS Tension pneumopericardium is a rare complication of a high-energy blunt thoracic trauma that manifests through hemodynamic instability. Its treatment requires early diagnosis and immediate decompression of the pericardial cavity, which should, where possible, be performed even before putting the patient on mechanical ventilation as ventilation bears a high risk of worsening the pneumopericardium due to the increased air pressure in the lungs. During diagnosis and treatment of associated injuries, we must bear in mind that the hemodynamic changes caused by pneumopericardium can mask typical signs of such injuries.
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Affiliation(s)
- Jana Pometlova
- Institute of Emergency Medicine, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava-Vitkovice, Czech Republic.,Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic
| | - Petr Handlos
- Institute of Forensic Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic
| | - Renata Jecminkova
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava-Vitkovice, Czech Republic.,Accident and Emergency Department, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic
| | - Miroslav Kitka
- Faculty of Medicine and Clinic of Trauma Surgery, Pavel Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Pavel Koscielnik
- Department of Radiology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic
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Reed N, Brennan ZJ, Kurle J. Stabbing on Six Mile: A Case Report of Tension Pneumopericardium Following Penetrating Trauma. Cureus 2022; 14:e27172. [PMID: 36017296 PMCID: PMC9393319 DOI: 10.7759/cureus.27172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
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Ahmed KM, Chan-Leveno TV, Lussier BL. Urgent decompression of tension pneumomediastinum in a patient to relieve elevated intracranial pressure: a case report. JOURNAL OF NEUROCRITICAL CARE 2022. [DOI: 10.18700/jnc.220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Timely recognition and intervention for venous outflow obstruction due to intrathoracic pathology are critical for controlling elevated intracranial pressure.Case Report: A 26-year-old man with pectus excavatum and a posterior fossa tumor requiring biopsy, decompression, and cerebrospinal fluid diversion developed pneumomediastinum following intubation with tension physiology and progressive elevation of intracranial pressure. Emergent tracheostomy was performed to decompress intrathoracic pressure, augment venous return, and ultimately expedite the patient’s definitive cancer therapy. Conclusion: Recognition of the mediastinal pathology leading to venous obstruction may be required for the management of malignant intracranial hypertension. Tracheostomy may be a means to decompress mediastinal pressure and augment venous outflow in rare cases of pneumomediastinum with tension physiology.
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9
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Kara S, Talalaev M, Yatzkan GD, Youssef P, Nedd K. Isolated Pneumopericardium: A Rare Complication Secondary to COVID-19 Infection. Cureus 2022; 14:e23431. [PMID: 35481291 PMCID: PMC9033636 DOI: 10.7759/cureus.23431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Pneumopericardium in the setting of COVID-19 is a rare incident. Typically, COVID-19 manifests with respiratory failure, cytokine storm, and gastrointestinal and cardiac symptoms. Chest X-ray (CXR) shows patchy peripheral opacities in bilateral lung fields and computed tomography (CT) shows multifocal ground-glass opacities in a COVID-19 patient. However, CXR is relatively less specific when compared to CT. In this case report, we present a case of isolated pneumopericardium (without pneumomediastinum) in a young female patient with COVID-19 pneumonia. Not only is the mechanism of development of pneumopericardium in COVID-19 patients poorly understood, but it is also considered a bad prognostic factor that leads to mortality.
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10
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Armstrong SM, Thavendiranathan P, Butany J. The pericardium and its diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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11
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Chaudhary H, Yousaf Z, Nasir U, Waheed T, Syed K. Spontaneous pneumomediastinum mimicking acute pericarditis. Clin Case Rep 2021; 9:e05156. [PMID: 34917373 PMCID: PMC8643493 DOI: 10.1002/ccr3.5156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/16/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
ST elevations on electrocardiogram (ECG) have a broad differential diagnosis that can vary from benign to more ominous pathologies. These include early repolarization, coronary vasospasm, acute pericarditis, ST-elevation myocardial infarction, ventricular aneurysms, and dissecting aneurysm of the aorta reaching the pericardium. ST-segment changes may also provide a clue to the presence of spontaneous pneumomediastinum (SPM). These ECG changes are seldom reported in literature. We describe two SPM cases with concomitant pneumopericardium that closely mimicked acute pericarditis with a deceptive clinical spectrum.
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Affiliation(s)
- Haseeb Chaudhary
- Department of MedicineReading HospitalTower Health SystemReadingPennsylvaniaUSA
| | - Zohaib Yousaf
- Department of MedicineHamad General HospitalDohaQatar
| | - Usama Nasir
- Department of MedicineReading HospitalTower Health SystemReadingPennsylvaniaUSA
| | - Tayyab Waheed
- Department of MedicineReading HospitalTower Health SystemReadingPennsylvaniaUSA
| | - Khezar Syed
- Department of MedicineReading HospitalTower Health SystemReadingPennsylvaniaUSA
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12
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Lee J, Ramkumar S, Ha P, Raghunath A, Dundon B. Pyopneumopericarditis from a gastropericardial fistula: a case report. Eur Heart J Case Rep 2021; 5:ytab408. [PMID: 34870085 PMCID: PMC8637813 DOI: 10.1093/ehjcr/ytab408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/07/2021] [Accepted: 09/14/2021] [Indexed: 11/14/2022]
Abstract
Background Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with associated inflammation of the fibrous pericardial sac. Case summary A 49-year-old gentleman was admitted with pyopneumoperciarditis on a background of a previous uncomplicated Roux-en-Y gastric bypass surgery performed 7 years prior. He underwent emergency surgery for an omental patch repair of an ulcer perforation involving the diaphragm and pericardium. His inpatient stay was complicated by persistent seropurulent output from the pericardial drain, loculated pleural effusion, and deconditioning. Discussion Management is extrapolated from the literature regarding purulent pericarditis. This condition albeit rare, requires swift recognition as without treatment mortality approaches 100%. Colchicine is an important adjunctive therapy postoperatively to prevent constrictive physiology.
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Affiliation(s)
- John Lee
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health , 246 Clayton Road , Clayton, VIC 3169, Australia
| | - Satish Ramkumar
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health , 246 Clayton Road , Clayton, VIC 3169, Australia
| | - Phil Ha
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health , 246 Clayton Road , Clayton, VIC 3169, Australia
| | - Ajay Raghunath
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health , 246 Clayton Road , Clayton, VIC 3169, Australia
| | - Benjamin Dundon
- Monash Cardiovascular Research Centre and MonashHeart, Monash Health , 246 Clayton Road , Clayton, VIC 3169, Australia
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Satyavolu B, Lodhi HA, Mathews A, Bansal P, Altaii H, Morcos R, Desai A, Maini B, Khalili H. A Rare Iatrogenic Trio: Pneumopericardium, Pneumoperitoneum, and Pericarditis. JACC Case Rep 2021; 3:1519-1523. [PMID: 34693351 PMCID: PMC8511468 DOI: 10.1016/j.jaccas.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
We present a rare case of iatrogenic pneumopericardium, pneumoperitoneum, and Escherichia coli pericarditis after emergency pericardiocentesis for pericardial tamponade. The patient had profound bowel distention at the time of the procedure that led to iatrogenic pericardioperitoneal fistula formation along with transverse colon perforation, which manifested later after pericardial drain removal. This condition required repeat pericardiocentesis, laparoscopic colon repair, a long course of antibiotics, and an eventual pericardial window. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Bharadwaj Satyavolu
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Hamza A. Lodhi
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Adithya Mathews
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Priya Bansal
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Haider Altaii
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Ramez Morcos
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Anand Desai
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Brijeshwar Maini
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
| | - Houman Khalili
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Internal Medicine, Delray Medical Center, Delray Beach, Florida, USA
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14
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Shih Y, Chen P, Hsu H, Tseng Y. Pneumopericardium secondary to oesophageal cancer presenting as myocardial infarction: a case report. Respirol Case Rep 2021; 9:e00791. [PMID: 34094576 PMCID: PMC8155694 DOI: 10.1002/rcr2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
The diagnosis of pneumopericardium can be challenging, as the symptoms are sometimes non-specific and can mimic those of other diseases. Especially, focal pneumopericardium presenting with regional ST-segment elevation on the electrocardiogram can be difficult to diagnose. Here, we present the case of a patient with pneumopericardium secondary to oesophageal cancer that was first diagnosed with community-acquired pneumonia and subsequently classified with acute coronary syndrome after an episode of cardiac arrest. The most prominent indication initially observed in this case was the history of oesophageal cancer and the presence of radiolucent areas in the heart under pleural effusion. When an unknown origin collapse develops in patients with oesophageal cancer, pneumopericardium should always be excluded, especially in cases where the cardiogenic shock is strongly suspected.
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Affiliation(s)
- Yu‐Shan Shih
- National Taiwan University College of MedicineTaipeiTaiwan
| | - Pei‐Hsing Chen
- Division of Thoracic Surgery, Department of SurgeryNational Taiwan University Hospital Yun‐Lin BranchDouliuTaiwan
| | - Hsao‐Hsun Hsu
- National Taiwan University College of MedicineTaipeiTaiwan
- Division of Thoracic Surgery, Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Yu‐Ding Tseng
- Division of Thoracic Surgery, Department of SurgeryNational Taiwan University Hospital Yun‐Lin BranchDouliuTaiwan
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15
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Ngo TK, Le DB, Bui HT, Pham VK. Symptomatic pneumopericardium - A rare complication following retroperitoneal laparoscopic nephrectomy: A case report. Int J Surg Case Rep 2021; 79:299-301. [PMID: 33508612 PMCID: PMC7840442 DOI: 10.1016/j.ijscr.2021.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Pneumopericardium is collection of gas in pericardial space. Retrospective reviews have described pneumopericardium as a complication of laparoscopic surgery, however, without any symptoms. By this report, we present a case who developed acute cardiopulmonary symptoms after retroperitoneal laparoscopic radical nephrectomy because of pneumopericardium. CASE PRESENTATION A 40-year-old Vietnamese woman was admitted due to left flank pain. She was diagnosed with left dysfunctional hydronephrosis and right urolithiasis. Six hours post-operation of an elective retroperitoneal laparoscopic radical nephrectomy, she suddenly developed severe substernal chest pain and dyspnea. Evaluations for acute myocardial infarction and pulmonary embolism were immediately ordered with no abnormality. However, computed tomography scan of the chest showed pneumopericardium, pneumomediastinum, subcutaneous emphysema, gas collection in sub-peritoneal space and next to the aortic arch. She was then closely monitored and effectively managed by conservative treatments. CLINICAL DISCUSSION Pneumopericardium is a rare complication of laparoscopy and mainly detected by radiographical measures incidentally. Several case studies reported symptomatic pneumopericardium, as in our presenting case. Some factors might contribute to the mechanism of our case that include retroperitoneal approach, thoroughly dissection the renal helium area and long-lasting operation. Post-operative collection of carbon dioxide is well self-limited; therefore, conservative treatments are efficient for stable cases. CONCLUSION Pneumopericardium following laparoscopy is uncommon, and mostly subclinical. However, it can manifest as acute cardiopulmonary symptoms and signs that require carefully evaluation. The presence of gas in pericardial space is a negative prognosis factor itself; consequently, clinicians should be aware of when managing pneumopericardium subsequent to laparoscopic procedures.
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Affiliation(s)
- Trung Kien Ngo
- Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam
| | - Duy Binh Le
- Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam.
| | - Hoang Thao Bui
- Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam
| | - Van Khiet Pham
- Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam
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Takamatsu K, Ohnishi H, Yokoyama A. Air Pericardial Tamponade Caused by Lung Cancer. Intern Med 2020; 59:3109-3110. [PMID: 32727990 PMCID: PMC7759701 DOI: 10.2169/internalmedicine.5247-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kazufumi Takamatsu
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Hiroshi Ohnishi
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
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17
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Anand R, Brooks Md Facs SE, Puckett Y, Richmond RE, Ronaghan CA. Pneumopericardium Resulting From Blunt Thoracic Trauma. Cureus 2020; 12:e11625. [PMID: 33376639 PMCID: PMC7755601 DOI: 10.7759/cureus.11625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pneumopericardium is a rare clinical condition defined by the presence of air in the pericardial sac. While this initially does not pose much danger, the accumulation of a sufficient amount of air can convert the pneumopericardium to a tension pathology. This may present with the classic signs, symptoms, and lethal dangers of cardiac tamponade. As with cardiac tamponade, treatment involves decompression of the pericardial sac through pericardiocentesis. This may be followed by insertion of a pericardial tube for continued drainage. While cardiac tamponade is well recognized by its classic findings, the rarer pneumopericardium may be more easily missed. This is further complicated by the backdrop of concurrent traumatic injuries in which it typically presents, as well as the absence of the defining accumulated pericardial effusion. We present a case of a 38-year old male who developed pneumopericardium and worsening hemodynamic status as a complication to blunt trauma, a rare etiology for this condition. CT of the chest demonstrated air in the pericardium and a coexisting pneumothorax. A bedside chest tube was placed. Upon resolution of the pneumothorax, his hemodynamic status improved. Repeat bedside ultrasound demonstrated complete resolution of his pneumopericardium. This case emphasizes the importance of early recognition and diagnosis of this rare yet easily missed condition.
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Affiliation(s)
- Rohan Anand
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Yana Puckett
- Surgery, West Virginia University School of Medicine, Charleston, USA
| | - Robyn E Richmond
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
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18
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Mindaye ET, Arayia A, Tufa TH, Bekele M. Iatrogenic pneumopericardium after tube thoracostomy: A case report. Int J Surg Case Rep 2020; 76:259-262. [PMID: 33053485 PMCID: PMC7566206 DOI: 10.1016/j.ijscr.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Iatrogenic pneumopericardium following tube thoracostomy is exceedingly rare. Delayed or missed diagnosis of iatrogenic pneumopericardium can be fatal. Infants tend to develop tension pneumopericardium urging surgical intervention. Iatrogenic pneumopericardium in infants can be managed conservatively with caution.
Introduction Pneumopericardium, the presence of air within the pericardial space, is a rare occurrence which usually follows positive pressure ventilation in infants, or blunt and penetrating thoracoabdominal injuries in adults. The occurrence of iatrogenic pneumopericardium following tube thoracostomy is extremely rare. Presentation of case We present a rare case of iatrogenic pneumopericardium in a 1 year and 7 months old female child for whom a left side tube thoracostomy was done using nasogastric tube for an indication of left empyema thoracis. Later, she developed progressively worsening shortness of breath and imaging revealed iatrogenic pneumopericardium. She was managed conservatively and discharged home in good condition. Discussion Iatrogenic pneumopericardium can have a range of presentations from being asymptomatic to features of cardiac tamponade. Patient management depends on the presence of tamponade effect and age of the patient. Infants tend to develop cardiac tamponade earlier urging surgical intervention but selected patients can be managed conservatively. Conclusion Iatrogenic pneumopericardium is a rare event but it might lead to death if not diagnosed and treated promptly. Although the tendency to develop tension pneumopericardium urging surgical intervention is high in pediatric patients, our patient has improved well with conservative management. While reporting of complications is not popular, this represents an opportunity to advance the safety during chest drain insertion.
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Affiliation(s)
- Esubalew Taddese Mindaye
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street 1271, Addis Ababa, Ethiopia.
| | - Abraham Arayia
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Tesfaye H Tufa
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Mahteme Bekele
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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19
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Tani M, Kanazawa T, Shioji N, Shimizu K, Iwasaki T, Morimatsu H. Successful treatment with positive airway pressure ventilation for tension pneumopericardium after pericardiocentesis in a neonate: a case report. JA Clin Rep 2020; 6:79. [PMID: 33029685 PMCID: PMC7541804 DOI: 10.1186/s40981-020-00384-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumopericardium in neonates is often associated with respiratory diseases, of which positive pressure ventilation (PPV) is an exacerbating factor. Here, we present a neonate case of pneumopericardium after cardiac surgery which was resolved after applying PPV. CASE PRESENTATION A 28-day-old neonate with left recurrent nerve palsy after aortic reconstruction for interrupted aortic arch developed pericardial effusion. Pericardiocentesis was performed under general anesthesia, and a drainage tube was left in the pericardium. After extubation, stridor gradually exacerbated, following hemodynamic deterioration. A chest X-ray demonstrated pneumopericardium. Upper airway stenosis due to recurrent nerve palsy developed excessive negative pleural pressure, and air was drawn into pericardium via the insertion site of the drainage tube. After tracheal intubation and applying PPV, the pneumopericardium improved. CONCLUSION PPV does not always exacerbate pneumopericardium. In a patient with pericardial-atmosphere communication, increased inspiration effort can cause pneumopericardium, and PPV is a therapeutic option to alleviate the pneumopericardium.
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Affiliation(s)
- Makiko Tani
- Department of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Tomoyuki Kanazawa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naohiro Shioji
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuyoshi Shimizu
- Department of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tatsuo Iwasaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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20
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Sherrier D, Lizardo RE. Spontaneous Pneumopericardium in a U.S. Marine: Do not Lose Heart. Mil Med 2020; 185:e518-e521. [PMID: 31560058 DOI: 10.1093/milmed/usz191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/14/2022] Open
Abstract
We report an unusual case of extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium identified in an otherwise healthy U.S. Marine who was enrolled in the Marine Corps School of Infantry. His training regimen included prolonged periods of yelling and elevation changes during sustained hiking through hilly terrain. The patient presented to the Fast Track with normal vital signs but complained of dyspnea, cough, and subjective fevers. Although he lacked a history of trauma, he was found to have pneumopericardium, pneumomediastinum, and subcutaneous emphysema without pneumothorax. He was admitted to the general surgery service for observation and was ultimately released back to his unit after 24 hours. To our knowledge, pneumopericardium has never been attributed to persistent yelling in the setting of a lower respiratory tract infection and should be considered in the differential of atraumatic chest symptomatology in otherwise healthy military service members.
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Affiliation(s)
- David Sherrier
- Department of Family Medicine, Naval Hospital Camp Pendleton, 200 Mercy Circle, Oceanside, CA 92055
| | - Radhames E Lizardo
- Department of Surgery, Naval Hospital Camp Pendleton, 200 Mercy Circle, Oceanside, CA 92055
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21
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Ali YZ, Aung H, Doll NJ, Pislaru SV. Post-surgical hydropneumopericardium: a case report of dramatic increase in the apparent size of pericardial effusion with positional changes. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-4. [PMID: 31911990 PMCID: PMC6939808 DOI: 10.1093/ehjcr/ytz160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/27/2019] [Accepted: 08/30/2019] [Indexed: 12/05/2022]
Abstract
Background Pneumopericardium is an uncommon clinical finding. It most commonly occurs after chest trauma but can also emerge as a complication following interventional or surgical procedures and can result in life-threatening complications. A high index of clinical suspicion should be present and once the condition is recognized, it should be managed promptly. Paucity of literature on pneumopericardium makes outlining any new case of paramount importance to emphasize the aspects of diagnosis and management of this rare condition. Case summary A 59-year-old woman with severe mitral valve and moderate tricuspid valve regurgitation underwent mitral and tricuspid valve repair with uneventful post-operative in-hospital stay. She presented 10 days after discharge with progressive shortness of breath. Chest X-ray revealed right hydropneumothorax. Transthoracic echocardiography (TTE) performed in the emergency department showed an apparently small pericardial effusion with patient in supine position; the effusion size increased substantially when imaging in left lateral decubitus, with presence of intrapericardial air bubbles. Computed tomography scan of the chest confirmed the presence of right hydropneumothorax and hydropneumopericardium, with a communicating pleuro-pericardial tract. The patient underwent chest tube placement which successfully decompressed both pleural and pericardial space. Discussion Hydropneumopericardium is a rare post-operative complication. Comprehensive TTE with imaging from multiple acoustic windows is mandatory when evaluating the extent of pericardial effusion. Presence of cardiac tamponade is crucial in determining the management plan.
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Affiliation(s)
- Yehia Z Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Htin Aung
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nathan J Doll
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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22
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Abstract
A term infant with cardiorespiratory failure treated with veno-venous extracorporeal membrane oxygenation developed pneumopericardium with cardiac tamponade while on the extracorporeal membrane oxygenation circuit. The patient was converted to veno-arterial extracorporeal membrane oxygenation and managed conservatively with spontaneous resolution of the air leak.
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Affiliation(s)
- Jasmeet Kataria-Hale
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Caraciolo J Fernandes
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Michael E Speer
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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23
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Affiliation(s)
| | - Ken Emoto
- Department of General Internal Medicine, Aso Iizuka Hospital, Japan
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24
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Bonardi CM, Spadini S, Fazio PC, Galiazzo M, Voltan E, Coscini N, Padalino M, Daverio M. Nontraumatic tension pneumopericardium in nonventilated pediatric patients: a review. J Card Surg 2019; 34:829-836. [PMID: 31269314 DOI: 10.1111/jocs.14159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Claudia M Bonardi
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Silvia Spadini
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paola C Fazio
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Moreno Galiazzo
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Elena Voltan
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Nadia Coscini
- Department for Community Child Health, Royal Children's Hospital, Melbourne, Australia
| | - Massimo Padalino
- Department of Cardiac, Thoracic and Vascular Sciences, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy
| | - Marco Daverio
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
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25
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Pandey AK, Singh SK, Devenraj V, Kumar S, Singh V. Pneumopericardium: a rare complication following pericardiocentesis. Indian J Thorac Cardiovasc Surg 2019; 35:493-495. [PMID: 33061035 DOI: 10.1007/s12055-018-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022] Open
Abstract
Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without any underlying cause in a healthy adult. Pneumopericardium following pericardiocentesis has been rarely reported in the literature. Pneumopericardium is often self-resolving and rarely requires a pericardial drain for treatment. We report a case of pneumopericardium presented with tamponade physiology following pericardiocentesis for tubercular pericardial effusion, requiring emergency pericardiectomy.
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Affiliation(s)
- Ajay Kumar Pandey
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, U.P. India
| | - Sushil Kumar Singh
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, U.P. India
| | - Vijayant Devenraj
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, U.P. India
| | - Sarvesh Kumar
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, U.P. India
| | - Vikas Singh
- Department of Cardiovascular and Thoracic Surgery, King George's Medical University, Lucknow, U.P. India
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26
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Melville JC, Balandran SS, Blackburn CP, Hanna IA. Massive Self-Induced Subcutaneous Cervicofacial, Pneumomediastinum, and Pneumopericardium Emphysema Sequelae to a Nondisplaced Maxillary Wall Fracture: A Case Report and Literature Review. J Oral Maxillofac Surg 2019; 77:1867.e1-1867.e8. [PMID: 31228425 DOI: 10.1016/j.joms.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/16/2022]
Abstract
Iatrogenic cervicofacial subcutaneous emphysema is a well-reported entity in the field of dentistry and oral and maxillofacial surgery, especially with the use of air-driven headpieces. Cervicofacial subcutaneous emphysema sequelae after maxillofacial trauma, however, has been reported less and the self-induced variant is even rarer. We report a case of massive cervicofacial subcutaneous emphysema, pneumomediastinum, and pneumopericardium in a healthy 16-year-old boy after blunt trauma to the face, which caused a nondisplaced anterior maxillary wall fracture. The findings from the present case report will validate the common phrase "no nose blowing or holding your sneezes" that clinicians tell patients after maxillofacial trauma and sinus surgery.
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Affiliation(s)
- James C Melville
- OMFS Internship Director, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, and Assistant Professor, Department of Oral, Head and Neck Oncology and Microvascular Reconstructive Surgery, School of Dentistry, Houston, TX.
| | - Steven S Balandran
- Postgraduate Year 2 Resident, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, School of Dentistry, Houston, TX
| | - Caleb P Blackburn
- Postgraduate Year 1 Resident, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, School of Dentistry, Houston, TX
| | - Issa A Hanna
- Chief, OMFS Service, Lyndon B. Johnson Hospital, and Associate Professor, Oral and Maxillofacial Surgery University of Texas Health Science Center at Houston, School of Dentistry, Houston, TX
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27
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Md Noor J, Eddie EA. Cardiac A-lines in fast scan as a sign of pneumopericardium. Ultrasound J 2019; 11:7. [PMID: 31359168 PMCID: PMC6638608 DOI: 10.1186/s13089-019-0123-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 12/04/2022] Open
Abstract
Background Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium. Case presentation A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis. Conclusions Although FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.
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Affiliation(s)
- Julina Md Noor
- Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh Campus, Jalan Hospital, 47000, Sg Buloh, Selangor, Malaysia.
| | - Elisa A Eddie
- Emergency & Trauma Department, Hospital Sg Buloh, Sg Buloh, Selangor, Malaysia
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28
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Ro A, Chiba S, Sagi M, Kageyama N, Hayashida M, Ikawa T, Oide Y, Ichiba K, Mukai T. Abdominal Stab Wounds with Tension Pneumopericardium Confirmed by Autopsy and Postmortem Computed Tomography. J Forensic Sci 2019; 64:1544-1547. [PMID: 30786026 DOI: 10.1111/1556-4029.14028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/02/2023]
Abstract
We present the first report of pneumopericardium observed by autopsy and on postmortem computed tomography (PMCT) images. The subject was a woman who died of self-inflicted stab wounds to the abdomen. The PMCT scan revealed air in the pericardial sac, a "flattened heart" sign, and retroperitoneal hemorrhage. Medicolegal autopsy revealed two abdominal stab wounds near the xiphoid process that had cut the apical pericardium and adjacent diaphragm and liver. Examination of the open thorax confirmed that the pericardial sac was distended with air. The wound extended to the abdominal aorta, causing retroperitoneal hemorrhage. PMCT images showed that the pneumopericardial volume was 133 mL. We believe that cardiac tamponade occurred resulting from the tension pneumopericardium; however, the effects were mitigated by hypovolemia secondary to the retroperitoneal hemorrhage as well as obstructive shock. Therefore, the cause of death appears to have been low-pressure cardiac tamponade.
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Affiliation(s)
- Ayako Ro
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Shoetsu Chiba
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Morihisa Sagi
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Norimasa Kageyama
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Makiko Hayashida
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Toru Ikawa
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Yukino Oide
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Kazue Ichiba
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
| | - Toshiji Mukai
- Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan
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Commentary: Sometimes two wrongs do make a right. J Thorac Cardiovasc Surg 2018; 158:e171. [PMID: 30392945 DOI: 10.1016/j.jtcvs.2018.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/23/2022]
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30
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Heuts S, Al Khoury F, Sardari Nia P. Lighthearted: Pneumopericardium after mitral valve repair. J Thorac Cardiovasc Surg 2018; 158:e169-e170. [PMID: 30366748 DOI: 10.1016/j.jtcvs.2018.08.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Firas Al Khoury
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Abstract
We report a case of a 32-year-old man with a past medical history of ethanol use disorder who was brought in unresponsive after inhaling six to 10 cans of the computer cleaning product, Dust-Off. After regaining consciousness, he endorsed severe, pleuritic chest and anterior neck pain. Labs were notable for elevated cardiac enzymes, acute kidney injury, and his initial electrocardiogram (ECG) revealed a partial right bundle branch block with a prolonged corrected QT interval (QTc). On chest X-ray as well as chest computed tomography, the patient was found to have pneumomediastinum, pneumopericardium, and subcutaneous emphysema. The patient’s course was uneventful and he was discharged home two days later after extensive substance abuse cessation counseling. Intentionally inhaling toxic substances, also known as “huffing,” is a dangerous new trend with significant consequences that clinicians need to be aware of and suspect in young patients presenting with chest pain. We present a rare case of pneumopericardium induced by inhalation of Dust-Off (1-1-difluoroethane).
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Affiliation(s)
| | - Jose Soriano
- Internal Medicine, Saint Francis Hosptial and Medical Center, Hartford, USA
| | - Deep Phachu
- Internal Medicine, University of Connecticut, Farmington, USA
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32
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Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis following Adenotonsillectomy: A Very Rare Complication. Case Rep Otolaryngol 2018; 2018:4531364. [PMID: 30210888 PMCID: PMC6120283 DOI: 10.1155/2018/4531364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/08/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022] Open
Abstract
Adenotonsillectomy is a common surgical otolaryngology procedure that is associated with several complications, including hemorrhage, odynophagia, damage to teeth, taste disorders, atlantoaxial subluxation, lingual edema, infection, and injury of the carotid artery. Pneumomediastinum, pneumopericardium, and epidural pneumatosis are an extremely unusual condition in children with adenotonsillectomy. Treatment should be conservative in the majority of cases and based on benign self-limiting course of these diseases; early recognition can prevent further complications. The combination of pneumomediastinum with epidural pneumatosis, pneumopericardium, retropharyngeal-prevertebral pneumatosis, axillar-perihumeral pneumatosis, and subcutaneous emphysema is also a very rare condition. We present a unique case with the radiological findings of air in all of these areas in a 6-year-old male child with adenotonsillectomy. The case was unusual in that the patient developed this complication 3 hours later after adenotonsillectomy with severe vomitting. The possible mechanism, the algorithm of treatment, and precautions in such cases will be discussed.
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Kemaloğlu C, Özçobanoğlu S, Köksel U, Kakillioğlu İ, Kemaloğlu MD, Erbasan O, Kısaoğlu A, Yaprak M, Aydınlı B, Bayezid Ö. Cardiac Tamponade Due to Pneumopericardium After Liver Transplant. EXP CLIN TRANSPLANT 2018; 17:568-570. [PMID: 30066625 DOI: 10.6002/ect.2017.0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pneumopericardium is a rare cause of cardiac tamponade, and it is an extremely rare complication of liver transplant. Here, we present a patient with cryptogenic liver cirrhosis who experienced cardiac tamponade secondary to a tension pneumopericardium during the postoperative course after liver transplant.
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Affiliation(s)
- Cemal Kemaloğlu
- From the Cardiovascular Surgery Department, School of Medicine, Akdeniz University
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34
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Maxson IN, Chandnani HK, Lion RP. The Heart's Halo: Caring for Pediatric Pneumopericardium. J Pediatr Intensive Care 2018; 7:213-215. [PMID: 31073498 DOI: 10.1055/s-0038-1653981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/15/2018] [Indexed: 10/16/2022] Open
Abstract
Pediatric pneumomediastinum and pneumopericardium (PPC) are rare complications, which can arise from various etiologies. We report a case of pediatric PPC secondary to an asthma exacerbation and discuss relevant diagnostic and management principles. Physicians must be aware of PPC and its implications due to the high mortality rate. PPC patients require close observation with continuous cardiorespiratory and telemetry monitoring, and providers experienced in the management of cardiac tamponade at a center capable of providing cardiothoracic surgical intervention. Time to resolution is multifactorial, but can be achieved promptly with supportive care and treatment of underlying condition.
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Affiliation(s)
- Ivanna N Maxson
- Department of Pediatrics, Loma Linda University, Loma Linda, California, United States
| | - Harsha K Chandnani
- Department of Pediatrics, Loma Linda University, Loma Linda, California, United States.,Division of Critical Care, Department of Pediatrics, Loma Linda University, Loma Linda, California, United States
| | - Richard Paul Lion
- Department of Pediatrics, Loma Linda University, Loma Linda, California, United States.,Division of Critical Care, Department of Pediatrics, Loma Linda University, Loma Linda, California, United States
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Thoracic trauma in fatal falls from height - Traumatic pneumopericardium correlates with height of fall and severe injury. Forensic Sci Med Pathol 2018; 14:188-193. [PMID: 29725818 DOI: 10.1007/s12024-018-9977-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
Pneumopericardium (PPC) describes the collection of gas in the pericardial sac. In tension Pneumopericardium (tPPC), this collection of gas may lead to cardiac tamponade. PPC following blunt trauma is considered a rare finding, as reflected by the low number of case reports on the topic. We analyzed the prevalence and pathophysiology of PPC and the associated trauma in 44 cases of falls from height. We retrospectively analyzed postmortem CT data and autopsy reports of fatal falls in the period March 2014-2017. A valid estimation of the height of the fall and a documented impact on an even and hard surface were inclusion criteria. A total of 44 cases were included in the study. We identified PPC in 18 of the 44 cases, and it was associated with an increased height of the fall, alongside aortic, pericardial, and myocardial ruptures. All cases with PPC also presented with bilateral pneumothorax. Five cases presented with a "ballooning" pericardium, indicating tPPC. PPC is a common finding in cases of falls from great heights. Due to a significant correlation with height and thus impact severity, PPC may be used as a reconstructive element in medico-legal investigations. Association with trauma makes PPC a sign of severe thoracic injury in postmortem and clinical radiology.
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36
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Shelke AB, Kawade R, Gandhi S. A case of bronchopericardial fistula with tension pneumopericardium closed successfully by transpericardial intervention: A novel procedure. Catheter Cardiovasc Interv 2017; 90:1117-1120. [PMID: 29068135 DOI: 10.1002/ccd.27376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/23/2017] [Accepted: 09/17/2017] [Indexed: 11/09/2022]
Abstract
A pneumopericardium is a collection of air or gas in the pericardial sac which may cause cardiac tamponade, known as tension pneumopericardium. Tension pneumopericardium is a rare and lethal presentation of bronchopericardial fistula. There are very few reports in the literature of patients surviving with this condition, although prompt diagnosis and early intervention are important. 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.
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Affiliation(s)
- Abhijeet B Shelke
- Department of Cardiology, Krishna Institute of Medical Sciences, Satara, Maharashtra, India
| | - Ramesh Kawade
- Department of Cardiology, Krishna Institute of Medical Sciences, Satara, Maharashtra, India
| | - Sourabh Gandhi
- Department of Medicine, Krishna Institute of Medical Sciences, Satara, Maharashtra, India
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37
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Duero Posada JG, Moayedi Y, Alhussein M, Bunce PE, Yau TM, Ross HJ. Early pneumopericardium after heart transplantation. Transpl Infect Dis 2017; 20. [PMID: 29105898 DOI: 10.1111/tid.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Juan G Duero Posada
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Yasbanoo Moayedi
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Mosaad Alhussein
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Paul E Bunce
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
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38
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Tension pneumopericardium following suicidal stab wounds to the chest. Forensic Sci Med Pathol 2017; 13:464-467. [DOI: 10.1007/s12024-017-9927-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 12/31/2022]
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39
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Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F, Boal L, Bárbara C. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. ACTA ACUST UNITED AC 2017; 43:101-105. [PMID: 28538776 PMCID: PMC5474372 DOI: 10.1590/s1806-37562016000000052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/15/2016] [Indexed: 02/04/2023]
Abstract
Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.
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Affiliation(s)
- Patrícia Dionísio
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luís Martins
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Susana Moreira
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Alda Manique
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rita Macedo
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fátima Caeiro
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luísa Boal
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Cristina Bárbara
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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40
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Torre S, Lee J, O'Connor S, Early SA, Ryan R. Acute Delayed Tension Pneumopericardium: The First Reported Case After Elective Lobectomy. Ann Thorac Surg 2017; 104:e333-e335. [PMID: 28935330 DOI: 10.1016/j.athoracsur.2017.04.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Salvatore Torre
- Cardiothoracic Surgery Unit, St. James's University Hospital, Dublin, Ireland.
| | - Jennifer Lee
- Cardiology Unit, St. James's University Hospital, Dublin, Ireland
| | - Stephen O'Connor
- Cardiology Unit, St. James's University Hospital, Dublin, Ireland
| | - Sarah A Early
- Cardiothoracic Surgery Unit, St. James's University Hospital, Dublin, Ireland
| | - Ronan Ryan
- Cardiothoracic Surgery Unit, St. James's University Hospital, Dublin, Ireland
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41
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Invasive Mucormycosis Induced Pneumopericardium: A Rare Cause of Pneumopericardium in an Immunocompromised Patient. Case Rep Infect Dis 2017; 2017:1424618. [PMID: 28596926 PMCID: PMC5449744 DOI: 10.1155/2017/1424618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/30/2017] [Indexed: 01/18/2023] Open
Abstract
Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium.
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42
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Frisoli TM, Jain T, Swadia T, Hong X, Guerrero M. Cardiac tamponade due to pyopneumopericardium from malignant bronchopericardial fistula. Neth Heart J 2017; 25:348-349. [PMID: 28349347 PMCID: PMC5405028 DOI: 10.1007/s12471-017-0961-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- T M Frisoli
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA.
| | - T Jain
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - T Swadia
- Department of Cardiology, Michigan Heart, St Joseph Mercy Health System, Livonia, MI, USA
| | - X Hong
- Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - M Guerrero
- Department of Cardiology, Evanston Hospital, North Shore University Health System, Evanston, IL, USA
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43
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Zarandy E, Counts S, Clemow C. Pneumomediastinum in a College-Aged Soccer Player: A Case Report. Curr Sports Med Rep 2017; 16:71-73. [PMID: 28282351 DOI: 10.1249/jsr.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Erik Zarandy
- AnMed Health, Department of Sports Medicine, Anderson, SC
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44
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Air tamponade of the heart. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:150-3. [PMID: 27516791 PMCID: PMC4971273 DOI: 10.5114/kitp.2016.61052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
Pneumopericardium is a rare disease defined as the presence of air or gas in the pericardial sac. Among the etiological factors, the following stand out: chest trauma, barotrauma, air-containing fistulas between the pericardium and the surrounding structures, secondary gas production by microorganisms growing in the pericardial sac, and iatrogenic factors. Until now, spontaneous pneumopericardium has been considered a harmless and temporary state, but a review of clinical cases indicates that the presence of air in the pericardium can lead to cardiac tamponade and life-threatening hemodynamic disturbances. We present the case of an 80-year-old patient with a chronic bronchopericardial fistula, who suffered from a cardiac arrest due to air tamponade of the heart.
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45
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Abstract
Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.
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46
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Rolim Marques AF, Lopes LH, Martins MDS, Carmona CV, Fraga GP, Hirano ES. Tension pneumopericardium in blunt thoracic trauma. Int J Surg Case Rep 2016; 24:188-90. [PMID: 27266838 PMCID: PMC4906123 DOI: 10.1016/j.ijscr.2016.04.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022] Open
Abstract
Tension pneumopericardium is a cause of shock in thoracic trauma. It should be regarded in hemodynamically unstable patients with blunt chest trauma. Immediate pericardium decompression may save the patient’s life.
Introduction Pneumopericardium, defined as the presence of gas in the pericardial sac, is a rare condition caused mostly by trauma. Tension pneumopericardium is a cause of hemodynamic instability; hence, it consists in a life-threatening situation and should be regarded in blunt chest trauma. Case report A 51-year-old male was victim of a 4 m fall and burial. He was stable upon admission and presented a simple pneumopericardium and pneumomediastinum on CT. While being submitted to an upper digestive endoscopy he presented respiratory failure and had to be intubated, suddenly evolving to shock. He was promptly referred to the operating room; a pericardial window confirmed tension pneumopericardium and immediately hemodynamic stability was restored. A pericardial drain was placed and kept for 15 days. He was discharged at the 18th day post-trauma after a satisfactory recovery at the trauma ICU. Discussion Blunt thoracic trauma causes pneumopericardium by various mechanisms. Tension pneumopericardium is a possible outcome, probably related to positive-pressure ventilation. It leads to hemodynamic instability and requires immediate decompression and placement of a pericardial drain.
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Affiliation(s)
- Antonio Fernando Rolim Marques
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
| | - Lizianne Hermogenes Lopes
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Marcela Dos Santos Martins
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Cesar Vanderlei Carmona
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Gustavo Pereira Fraga
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Elcio Shiyoti Hirano
- Trauma Division, Department of Surgery, University of Campinas Teaching Hospital, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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47
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Iskander S, Amar H, Audrey B, Fabien D. Pneumopericardium: A Rare Complication of Pericardiocentesis. J Cardiovasc Ultrasound 2016; 24:55-9. [PMID: 27081445 PMCID: PMC4828415 DOI: 10.4250/jcu.2016.24.1.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/24/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022] Open
Abstract
Pneumopericardium is defined by the presence of air in the pericardial cavity. It is a rare entity occurring most commonly after trauma. Pneumopericardium resulting after pericardiocentesis is even rarer. We report a case of 46-year-old man, with end-stage renal disease on chronic hemodialysis and who developed a large circumferential pericardial effusion of 40 mm in diastole with swinging heart and diastolic right atrium collapse requiring pericardiocentesis. Few days after, the patient complained of pleuritic chest pain and echocardiogram revealed several tiny sparkling echogenic spots swirling in the pericardial sac. Computed tomography scans revealed a marked anterior pneumopericardium that was conservatively managed.
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Affiliation(s)
- Slama Iskander
- Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps, Gap, France
| | - Hidoud Amar
- Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps, Gap, France
| | - Boudes Audrey
- Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps, Gap, France
| | - Devemy Fabien
- Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps, Gap, France
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48
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Mohamad Yusof A, Tang SSP, Teo R, Wan Mat WR, Izaham A, Abdul Rahman R. Air in the pericardial sac post tracheostomy: One should be aware. J Acute Med 2016. [DOI: 10.1016/j.jacme.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Lee J, Kang BS, Kim C, Choi HJ. Tension Pneumopericardium after Pericardiocentesis. J Korean Med Sci 2016; 31:470-2. [PMID: 26952636 PMCID: PMC4779876 DOI: 10.3346/jkms.2016.31.3.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022] Open
Abstract
Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
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Affiliation(s)
- Jinhyuck Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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50
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Abboud ME, Frasure SE. Adult Female With Dyspnea. Ann Emerg Med 2016; 67:318, 328. [DOI: 10.1016/j.annemergmed.2015.07.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 10/22/2022]
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