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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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2
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Pearl L, Kerby E, Pansuriya S, Alnajjar R, Lim J. Tension Pneumopericardium Causing Cardiogenic Shock due to Blunt Injury to the Chest. Am Surg 2023; 89:3889-3890. [PMID: 37158506 DOI: 10.1177/00031348231175125] [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: 05/10/2023]
Abstract
Pneumopericardium is an exceptionally uncommon phenomenon in the setting of blunt polytrauma. It is imperative for trauma providers to identify tension pneumopericardium despite its rarity. A 22-year-old male motorcyclist presented to the hospital after colliding with a car going approximately 50 mph. The patient was hemodynamically unstable and had diminished breath sounds bilaterally. Bilateral chest tubes were placed, yielding little improvement in condition. While obtaining CT imaging, pneumopericardium was promptly identified. Pulses were lost immediately before pericardiocentesis, and resuscitative thoracotomy was performed. The pericardial sac was tense and an immediate gush of air released upon incising the sac. The patient was taken immediately to the Operating Room for further exploration and repair.
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Affiliation(s)
- Leah Pearl
- Henry Ford Macomb Hospital - Clinton Township, Clinton township, MI, USA
| | - Emily Kerby
- Henry Ford Macomb Hospital - Clinton Township, Clinton township, MI, USA
| | - Shyamal Pansuriya
- Henry Ford Macomb Hospital - Clinton Township, Clinton township, MI, USA
| | - Raed Alnajjar
- Henry Ford Macomb Hospital - Clinton Township, Clinton township, MI, USA
| | - John Lim
- Henry Ford Macomb Hospital - Clinton Township, Clinton township, MI, USA
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3
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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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Nasr A, Alsadery H, Osman A, Alblowi A, Bamalan O, Alshaikhi A, Alosaimi N, ElGhoneimy Y, Nabri M. Trauma-related pneumopericardium: A literature review. SAUDI JOURNAL FOR HEALTH SCIENCES 2023. [DOI: 10.4103/sjhs.sjhs_146_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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5
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Pneumopericardium due to blunt trauma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.889718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Ouachaou J, Laaribi I, Mimouni H, Mellagui Y, Bkiyar H, Housni B. Post-traumatic compressive pneumopericardium with spontaneous ventilation: Case report. Respir Med Case Rep 2021; 32:101354. [PMID: 33614406 PMCID: PMC7879037 DOI: 10.1016/j.rmcr.2021.101354] [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: 06/14/2020] [Revised: 08/13/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022] Open
Abstract
Pneumopericardium is a rare complication of a blunt thoracic trauma. It is defined as the presence of air in the pericardial sac. There are just a few cases described in the literature. This article brings pneumopericardium to light, reinforcing the importance of considering it within the blunt chest trauma and remarking its management with a careful monitoring for the patients whose stable or even asymptomatic with spontaneous ventilation because of the risk of tension pneumopericardium and cardiac arrest. Diagnosis is often difficult, and it can be life-threatening by the occurrence of gas tamponade. We report the case of a 48 years old patient victim of a severe traumatism with pneumothorax and pneumopericardium; he was stable with spontaneous ventilation.
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Affiliation(s)
- Jamal Ouachaou
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Ilyass Laaribi
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Hamza Mimouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Yassine Mellagui
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
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7
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Winterton J, Biart S. Spontaneous pneumomediastinum and pneumopericardium in a young healthy adult with plans for air travel. Clin Case Rep 2020; 8:3075-3078. [PMID: 33363883 PMCID: PMC7752392 DOI: 10.1002/ccr3.3339] [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: 06/13/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/09/2022] Open
Abstract
Although rare, pneumomediastinum and pneumopericardium should be considered in patients presenting with sudden onset post-tussive chest discomfort.
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Affiliation(s)
| | - Simon Biart
- Acute Medical UnitArrowe Park HospitalWirralUK
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8
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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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9
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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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10
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Abelhad NI, Bravo-Jaimes K, Fuentes F. Tension Pneumopericardium in the Intensive Care Unit. Tex Heart Inst J 2020; 47:335-336. [PMID: 33472235 DOI: 10.14503/thij-19-6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nadia Isabel Abelhad
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
| | - Francisco Fuentes
- Department of Cardiovascular Medicine, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, Texas 77030
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11
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Pneumopericardium following blunt trauma: Case report. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Shalaby AAEM. Commentary Letter: Pneumopericardium Following Blunt Trauma. CLINICAL CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2019:40-41. [DOI: 10.33805/2639.6807.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Pneumopericardium is presence of air within the pericardial space. It is rare complication of blunt or penetrating chest trauma and may also occur iatrogenically. A case report of pneumopericarium caused by blunt chest trauma, condition was diagnosed by chest CT (Computed Tomography) scan; patient was vitally stable and managed conservatively with spontaneous resolution of pneumopericardium 10 days after admission.
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13
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Sutherland T, Parsons S, Cordner S, O'Donnell C. Tension pneumopericardium following blunt chest trauma. J Med Imaging Radiat Oncol 2019; 63:358-359. [DOI: 10.1111/1754-9485.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tom Sutherland
- Medical Imaging Department St Vincent's Hospital Fitzroy Victoria Australia
- Faculty of Medicine Dentistry and Health Science University of Melbourne Melbourne Victoria Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| | - Stephen Cordner
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| | - Chris O'Donnell
- Victorian Institute of Forensic Medicine Melbourne Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
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14
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Bartolek Hamp D, Letica Brnadić R, Cavrić G, Daraboš N. Occult pneumopericardium after isolated blunt chest trauma. Postgrad Med J 2019; 95:343. [PMID: 31004042 DOI: 10.1136/postgradmedj-2019-136489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/30/2019] [Accepted: 04/08/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Dubravka Bartolek Hamp
- Anesthesiology, Reanimation and Intensive Medicine, University Hospital Centre Zagreb, Zagreb, Croatia .,Josip Juraj Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia
| | - Renata Letica Brnadić
- Anesthesiology and Intensive Care Medicine, Clinical Hospital Sisters of Mercy Clinic for Traumatology, Zagreb, Croatia
| | - Gordana Cavrić
- Clinic of Internal Medicine, Emergency Department, Merkur Clinical Hospital, Zagreb, Croatia
| | - Nikica Daraboš
- Clinic of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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15
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Lonský V, Manďák J, Harrer J, Tuna M, Dvořák P, Dědek T, Dominik J. Posttraumatic Pneumopericardium: A Sign of Severe Injury or Radiodiagnostic Rarity? ACTA MEDICA (HRADEC KRÁLOVÉ) 2018. [DOI: 10.14712/18059694.2017.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present three cases of pneumopericardium following blunt chest trauma injury. All three patients were victims of road traffic accidents. All had multiple associated injuries and pneumopericardium was found as the additional finding. Pneumopericardium was treated conservatively with thoracic drains placement and patients observation. Transesophageal echocardiography was used as a method of choice for exclusion of cardiac air tamponade. All three patients survived.
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16
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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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17
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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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18
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Verma N, Robinson JD, Gunn ML. Pericardial rupture and cardiac herniation in blunt trauma. Radiol Case Rep 2018; 13:573-575. [PMID: 29988807 PMCID: PMC6030551 DOI: 10.1016/j.radcr.2018.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Pericardial rupture in blunt trauma is rarely seen on computed tomography (CT) imaging due to its high initial mortality. We report a case of a 53-year-old man who presented to the Emergency Department in hemodynamic shock after intentional fall from height. Chest radiograph, which was taken in the trauma bay as a part of his primary survey, showed abnormal mediastinum contour with pneumopericardium. Pericardial rupture with cardiac herniation, and tamponade secondary to pneumopericardium, was diagnosed on trauma CT scan. The patient underwent emergent surgical management with thoracotomy to reduce the herniation and repair the pericardium. Immediate suspicion for pericardial and cardiac injury on the initial chest radiograph and rapid diagnosis on CT was indispensable for this patient's favorable outcome.
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Affiliation(s)
- Nupur Verma
- University of Florida, Department of Radiology, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | - Jeffery D Robinson
- University of Washington, Harborview Medical Center, Department of Radiology, 325 9th Ave., Seattle, WA 98104, USA
| | - Martin L Gunn
- University of Washington, Harborview Medical Center, Department of Radiology, 325 9th Ave., Seattle, WA 98104, USA
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19
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Lamba A, Dutta R, Chand RK. Pneumopericardium after minimally invasive atrial septal defect closure. Ann Card Anaesth 2018; 21:99-100. [PMID: 29336408 PMCID: PMC5791506 DOI: 10.4103/aca.aca_37_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.
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Affiliation(s)
- Aditya Lamba
- Department of Cardiac Anaesthesia, Max Superspeciality Hospital, New Delhi, India
| | - Rahul Dutta
- Department of Cardiac Anaesthesia, Max Superspeciality Hospital, New Delhi, India
| | - Rajesh K Chand
- Department of Cardiac Anaesthesia, Max Superspeciality Hospital, New Delhi, India
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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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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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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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[Pneumopericardium due to thorax compression : Overlooked resuscitation injury]. Anaesthesist 2015; 64:943-947. [PMID: 26467046 DOI: 10.1007/s00101-015-0104-9] [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: 05/04/2015] [Revised: 09/04/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
Abstract
On postoperative day 15 after right upper lobectomy of a non-small cell lung cancer a 75-year-old patient developed bradycardia followed by asystole during hospitalization on the intensive care unit. After approximately 4 min of chest compressions, circulatory function was re-established but the patient suffered from tachycardia and required continuous vasopressor support. To exclude hypovolemia and assess contractility, transthoracic echocardiography (TTE) was conducted. During the TTE examination neither the intensive care physician nor the cardiologist on call could obtain usable images, which was explained by the lack of experience of both physicians with TTE. Both chest ultrasound and chest x-ray imaging did not reveal any signs of a pneumothorax. A small zone of increased transparency in the cardiac silhouette was not considered to be of pathological relevance. Slowly, the patient recovered. On the following day, a thoracic computed tomography (CT) scan showed an extensive pneumopericardium of the entire pericardium with a seam width of 3 cm. Because of the patient's clinical improvement, a decision for a conservative therapeutic approach was made and 24 h later the seam width was reduced to 2 cm and 9 days later it was no longer detectable. After a total stay of 24 days in the intensive care unit the patient was transferred to a long-term pulmonary care weaning facility. In retrospect, the pneumopericardium as a rare resuscitation injury was the cause for the poor TTE conditions and was overlooked due to a fixation error, because too much attention had been focused only on the detection of a pneumothorax.
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Nachi S, Okada H, Kato H, Suzuki K, Nakano S, Yoshida T, Yoshida S, Ushikoshi H, Toyoda I, Ogura S. Simple pneumopericardium due to blunt trauma progressing to tension pneumopericardium during transportation. Am J Emerg Med 2015; 34:933.e3-5. [PMID: 26472505 DOI: 10.1016/j.ajem.2015.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/06/2015] [Indexed: 11/30/2022] Open
Abstract
Patients with simple pneumopericardium due to blunt thoracic trauma occasionally progressed to tension pneumopericardium, although pneumopericardium is believed to be benign in general. A 65-year-old man had both arms caught in a grinding machine and his face struck hard at work. He was diagnosed with bilateral degloving injuries of both arms and mediastinal emphysema on computed tomography. He required transfer to an advanced emergency medical service center for treatment. Although he was hemodynamically stable then, the patient's condition deteriorated during transportation. The patient returned to the local hospital as cardiopulmonary resuscitation continued, repeat computed tomography was performed, which showed a substantial pneumopericardium and exacerbation of mediastinal and subcutaneous emphysema. After then, cardiopulmonary resuscitation was discontinued because there was no response. For the patient to be rescued in this situation, thoracotomy is required, although it should be reserved for patients with evidence of hemodynamic compromise attributable to cardiac tamponade.
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Affiliation(s)
- Sho Nachi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Hisaaki Kato
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kodai Suzuki
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shiho Nakano
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takahiro Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shozo Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroaki Ushikoshi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Izumi Toyoda
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Hassan EA, Torad FA, Shamaa AA. Pneumopericardium Secondary to Pneumomediastinum in a Golden Retriever Dog. Top Companion Anim Med 2015; 30:62-4. [PMID: 26359726 DOI: 10.1053/j.tcam.2015.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 07/03/2015] [Indexed: 11/11/2022]
Abstract
Pneumopericardium is a rare finding that has been previously reported following spontaneous, traumatic, or iatrogenic causes. A 3-year old Golden Retriever dog was admitted with respiratory distress after falling from a height. Clinical and electrocardiographic findings were nonspecific. Thoracic radiography revealed hyperinflated lung with sharp outlining of the mediastinal structures. A well-demarcated region of radiolucent gas opacity was seen surrounding the cardiac silhouette. Echocardiography revealed intense hyper-reflective shadows all over the heart. Echocardiographic measurements were within the reference range. The dog responded well to conservative medical therapy. Pneumopericardium was reported secondary to pneumomediastinum; pneumopericardium is self-limiting unless other complications develop.
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Affiliation(s)
- Elham A Hassan
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt.
| | - Faisal A Torad
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Ashraf A Shamaa
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
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27
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Chan WM, Love JD. Tracheal injury leading to tension pneumopericardium in a blunt trauma victim. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408614554412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tracheal injury is uncommon in blunt thoracic trauma which may lead to subcutaneous emphysema and pneumomediastinum but rarely does it lead to tension pneumopericardium. We present a case of a 75-year-old female involved in a motor vehicle collision leading to multiple injuries including a tracheal injury associated with tension pneumopericardium seen on computed tomography. The patient underwent a pericardial window for decompression of her cardiac tamponade.
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Affiliation(s)
- Winston M Chan
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, USA
| | - Joseph D Love
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, USA
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Myszka W, Nowak A. Chest pain, dyspnoea and hypotension in a 61-year-old woman. Heart 2015; 101:960. [PMID: 25694187 DOI: 10.1136/heartjnl-2014-307211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/26/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Waldemar Myszka
- Department of Internal Medicine, Cardiology and Hypertension, HCP Medical Center in Poznan, Poznan, Poland Department of Clinical Biochemistry and Laboratory Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Agata Nowak
- Department of Internal Medicine, Cardiology and Hypertension, HCP Medical Center in Poznan, Poznan, Poland Department of Clinical Biochemistry and Laboratory Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Nicol AJ, Navsaria PH, Hommes M, Edu S, Kahn D. Management of a pneumopericardium due to penetrating trauma. Injury 2014; 45:1368-72. [PMID: 24629700 DOI: 10.1016/j.injury.2014.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A pneumopericardium presenting after penetrating chest trauma is a rare event. The surgical management of this clinical problem has not been clearly defined. The aim of this study was to document the mode of presentation and to suggest a protocol for management. PATIENT AND METHODS A review of a prospectively collected cardiac database of patients presenting to Groote Schuur Hospital Trauma Centre between October 2001 and February 2009 with a pneumopericardium on chest X-ray after penetrating trauma. RESULTS There were 27 patients with a pneumopericardium (mean age 25 years, range 17-36). The mechanism of injury was a stab wound to the chest in 26 patients and a single patient with multiple low velocity gunshot wounds. Six patients (22%) were unstable and required emergency surgery. One of these patients presented with a tension pneumopericardium. Twenty-one patients were initially stable. Two of these (10%) patients later developed a tension pneumopericardium within 24-h and were taken to theatre. The remaining 19 patients were managed with a subxiphoid pericardial window (SPW) at between 24 and 48h post admission. Ten of these 19 patients (52%) were positive for a haemopericardium. Only 4 of the 19 underwent a sternotomy and only two of these had cardiac injuries that had sealed. There were no deaths in this series. CONCLUSION Patients with a penetrating chest injury with a pneumopericardium who are unstable require emergency surgery. A delayed tension pneumopericardium developed in 10% of patients who were initially stable. It is our recommendation that all stable patients with a pneumopericardium after penetrating chest trauma should undergo a SPW. A sternotomy is not required in stable patients.
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Affiliation(s)
- Andrew J Nicol
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Pradeep H Navsaria
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Martijn Hommes
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sorin Edu
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Delawir Kahn
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Visser F, Heine M, Levin AI, Coetzee AR. Pneumopericardium:two case reports and a review. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2008.10872544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pneumomediastinum associated with pneumopericardium and epidural pneumatosis. Case Rep Emerg Med 2014; 2014:275490. [PMID: 24955261 PMCID: PMC4052931 DOI: 10.1155/2014/275490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/02/2014] [Indexed: 12/05/2022] Open
Abstract
Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.
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Uluçam MZ. An extremely rare combination: pneumopericardium, pneumoperitoneum, and subcutanous emphysema-a case report. Cardiol Ther 2013; 2:103-10. [PMID: 25135293 PMCID: PMC4107440 DOI: 10.1007/s40119-012-0008-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 12/27/2022] Open
Abstract
Pneumopericardium, an accumulation of air in the pericardial cavity, occurs very rarely as compared to pneumothorax and pneumomediastinum. Clinical presentation is variable, patients are frequently asymptomatic, and mild cases usually resolve spontaneously. However, it may lead to pericardial tamponade, which requires rapid diagnosis and treatment that can be lifesaving. The traditional diagnostic, simple method of diagnosis is via an upright chest X-ray. Typical findings can be detected and a differential diagnosis can be made between pneumomediastinum and pneumopericardium. Echocardiography and chest computed tomography scans can also support the diagnosis. Only one case of pneumopericardium after surgical pericardiotomy has been reported in the literature so far. In this case report, iatrogenic pneumopericardium, which resolved spontaneously after surgical pericardiotomy, was reported in a 19-year-old patient who had a rejected liver transplantation, and had liver and kidney failure with pericardial tamponade. In this case, pneumopericardium was accompanied by pneumoperitoneum and subcutaneous emphysema; an extremely rare combination.
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Affiliation(s)
- Melek Zekiye Uluçam
- Cardiology Department, Baskent University School of Medicine, Ankara, Turkey,
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Vanzo V, Bugin S, Snijders D, Bottecchia L, Storer V, Barbato A. Pneumomediastinum and pneumopericardium in an 11-year-old rugby player: a case report. J Athl Train 2013; 48:277-81. [PMID: 23672393 DOI: 10.4085/1062-6050-48.1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pneumomediastinum and pneumopericardium are rare occurrences in young athletes, but they can result in potentially life-threatening consequences. BACKGROUND While involved in a rugby match, an 11-year-old boy received a chest compression by 3 players during a tackle. He continued to play, but 2 hours later, he developed sharp retrosternal chest pain. A chest radiograph and an echocardiograph at the nearest emergency department showed pneumopericardium and pneumomediastinum. DIFFERENTIAL DIAGNOSIS Sternal and rib contusions, rib fractures, heartburn, acute asthma exacerbation, pneumomediastinum, pneumopericardium, pneumothorax, traumatic tracheal rupture, myocardial infarction, and costochondritis (Tietze syndrome). TREATMENT Acetaminophen for pain control. UNIQUENESS To our knowledge, this is the only case in the international literature of the simultaneous occurrence of pneumomediastinum and pneumopericardium in a child as a consequence of blunt chest trauma during a rugby match. CONCLUSIONS Pneumomediastinum and pneumopericardium may be consequences of rugby blunt chest trauma. Symptoms can appear 1 to 2 hours later, and the conditions may result in serious complications. Immediate admission to the emergency department is required.
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Biswas S, Cahill P, Sherck J. The Way to a Man's Heart is through his Stomach – Peanuts in the Pericardium! a Rare Case of Traumatic Gastropericardial Fistula. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumopericardium is most commonly iatrogenic and in cases of gastropericardial fistula, the stomach is usually intrathoracic. We report a case of penetrating trauma induced gastropericardial fistula from an intraabdominal stomach resulting in pneumopericardium. The diagnosis was confirmed during laparotomy. Pneumopericardium, if small, can be managed conservatively, but immediate release is required if tension occurs. Gastropericardial fistula carries a high mortality and should be surgically repaired.
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Affiliation(s)
| | - P Cahill
- Santa Clara Valley Medical Center, Department of Trauma and Critical Care, 751 S. Bascom Avenue, San Jose, California 95128, USA
| | - J Sherck
- Santa Clara Valley Medical Center, Department of Trauma and Critical Care, 751 S. Bascom Avenue, San Jose, California 95128, USA
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Sekhar A, Raheja P, Ikram S. The Macklin effect causing a pneumopericardium. J Cardiovasc Med (Hagerstown) 2012; 13:527-8. [DOI: 10.2459/jcm.0b013e328356bc37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Eichhorn F, Heussel CP, Storz K, Dreher S, Dienemann H. [Dyspnea, cough and tachycardia]. Med Klin Intensivmed Notfmed 2012; 107:285-8. [PMID: 22349540 DOI: 10.1007/s00063-012-0085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
Abstract
Pneumopericardium is known as a rare complication following cardiothoracic surgery or intravenous line placement. Baseline examination including chest x-ray may lead to diagnosis. To prevent cardiac tamponade, pericardiotomy or adaequate pericardial drainage is crucial. We revealed pneumopericardium as the reason for new dyspnea and tachycardia in a 56-year-old man 3 weeks after lobectomy and lymphadenectomy because of a non-small cell lung cancer. Early decision for transpleural pericardiotomy prevented a possibly lethal course.
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Affiliation(s)
- F Eichhorn
- Abteilung für Thoraxchirurgie, Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany.
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Abstract
A 21-year-old man presented to the emergency department with pain and swelling to the right side of his neck and chest wall with associated shortness of breath. Two days earlier, while playing football, he had been involved in a minor collision with another player where he was struck on the right side of his head, but had managed to continue playing. On examination, the patient had extensive cervical surgical emphysema. There were no further positive findings on respiratory and general examination. A chest x-ray demonstrated no rib or clavicular fractures and no pneumothorax. Therefore, a CT was undertaken to ascertain the cause of the surgical emphysema. This demonstrated a pneumomediastinum, pneumopericardium and extradural air in the spinal column in addition to the subcutaneous air. The CT identified no bony trauma and no other injuries. The symptoms resolved spontaneously and follow-up radiography, 9 days later, showed no residual air.
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Affiliation(s)
- Tania Minns
- Emergency Department, Royal Liverpool University Hospital, Liverpool, UK
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O'Connor JV, Scalea TM. Tension pneumopericardium after blunt thoracic trauma. Ann Thorac Surg 2010; 90:1713. [PMID: 20971305 DOI: 10.1016/j.athoracsur.2010.01.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 01/15/2010] [Accepted: 01/20/2010] [Indexed: 11/28/2022]
Affiliation(s)
- James V O'Connor
- University of Maryland, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Bhullar IS, Wagner S. Management of Cardiac Tamponade Secondary to Pneumomediastinum after Blunt Thoracic Trauma. Am Surg 2010. [DOI: 10.1177/000313481007600607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Indermeet S. Bhullar
- Department of Surgery University of Florida–Shands Hospital Jacksonville, Florida
| | - Shaun Wagner
- Lake Erie College of Osteopathic Medicine Erie, Pennsylvania
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40
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Durando MM, Zarucco L, Schaer TP, Ross M, Reef VB. Pneumopericardium in a horse secondary to sternal bone marrow aspiration. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2006.tb00419.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Markarian MK, MacIntyre DA, Cousins BJ, Fildes JJ, Malone A. Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection. Am J Emerg Med 2008; 26:515.e1-2. [PMID: 18410829 DOI: 10.1016/j.ajem.2007.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Accepted: 08/09/2008] [Indexed: 10/22/2022] Open
Abstract
A 15 year old male was an unrestrained passenger in a high speed motor vehicle crash followed by ejection. The patient was noted to have evidence of bilateral pneumothorax upon arrival in the Emergency Department. Bilateral chest tubes were placed under sterile conditions; however, the left pneumothorax remained, and a second left chest tube was placed. Repeat chest radiographs revealed extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium. Needle aspiration of the pericardium returned significant quantities of air, an immediate improvement in blood pressures followed. An 18-gauge triple lumen catheter was placed into the pericardial space for additional withdrawal of air via syringe. Mechanisms have been proposed to explain the development of tension pneumopericardium after chest trauma. Early diagnosis is crucial, and may be found on initial chest radiographs. Computed tomography is also an effective method for evaluating the presence of air in the pericardial space and may assist in establishing the diagnosis. Tension pneumopericardium requires immediate recognition and decompression to prevent cardiac tamponade with a fatal circulation collapse, an entity that is as serious as the tamponade resulting from hemopericardium. Traumatic pneumopericardium is rare, but can be a complicated finding associated with high-speed blunt chest trauma. Patients with evidence of pneumopericardium should be closely monitored, particularly those supported by positive pressure ventilation.
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Affiliation(s)
- Mark K Markarian
- Texas Tech University Health Sciences Center, Department of Surgery, Lubbock, TX 79430, USA.
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Zakynthinos E, Karetsi E, Diakaki C. Pneumopericardium after blunt chest trauma: Mechanical ventilation with positive pressure must be avoided. Int J Cardiol 2008; 124:e8-e10. [PMID: 17346826 DOI: 10.1016/j.ijcard.2006.11.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 11/18/2006] [Indexed: 11/21/2022]
Abstract
A 38-year-old polytraumatized man was admitted with signs of cardiogenic shock (low blood pressure, tachycardia, tachypnea, and elevated central venous pressure). A near tension pneumopericardium was revealed by thorax CT. Air from the pericardial sac remissed 4 days later conservatively, avoiding invasive or non-invasive mechanical ventilation. The use of positive-pressure ventilation, with or without intubation, would probably lead to tension pneumopericardium-cardiac tamponade, needing emergent decompression.
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Celik T, Iyisoy A, Kursaklioglu H, Gunay C, Yuksel UC, Isik E. A Case of Pneumopericardium Following Endomyocardial Biopsy. J Card Surg 2007; 22:519-21. [PMID: 18039219 DOI: 10.1111/j.1540-8191.2007.00453.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Turgay Celik
- Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey.
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Restrepo CS, Lemos DF, Lemos JA, Velasquez E, Diethelm L, Ovella TA, Martinez S, Carrillo J, Moncada R, Klein JS. Imaging Findings in Cardiac Tamponade with Emphasis on CT. Radiographics 2007; 27:1595-610. [PMID: 18025505 DOI: 10.1148/rg.276065002] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- C Santiago Restrepo
- Department of Radiology, University of Texas Health Sciences Center, San Antonio, USA
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Levin AI, Visser F, Mattheyse F, Coetzee A. Tension pneumopericardium during positive-pressure ventilation leading to cardiac arrest. J Cardiothorac Vasc Anesth 2007; 22:879-82. [PMID: 18834762 DOI: 10.1053/j.jvca.2007.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Ian Levin
- Department of Anesthesiology and Critical Care, University of Stellenbosch and Tygerberg Academic Hospital, Tygerberg, Cape Town, South Africa.
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Petteruti F, Stassano P, De Luca G, Di Tommaso L, Luciano A, Pepino P. Tension pneumopericardium and pneumothorax during spontaneous ventilation. J Thorac Cardiovasc Surg 2007; 133:829-30. [PMID: 17320605 DOI: 10.1016/j.jtcvs.2006.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2006] [Revised: 10/28/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Francesco Petteruti
- Cardiothoracic Surgery Department, Clinica Pineta Grande Castelvolturno, CE, Naples, Italy.
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Haddad R, Lima CET, Boasquevisque CH, Haddad GS, Ferreira TD. Pneumothorax and tension pneumopericardium following cardiothoracic surgery. J Bras Pneumol 2007; 32:84-7. [PMID: 17273574 DOI: 10.1590/s1806-37132006000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Accepted: 05/05/2005] [Indexed: 11/21/2022] Open
Abstract
Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.
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Affiliation(s)
- Rui Haddad
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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49
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Abstract
Pneumopericardium, or air within the pericardial sack, generally occurs after high-speed blunt deceleration injuries. Although it is generally relatively benign, in rare instances, it can become hemodynamically significant. The diagnosis is easily made on plain chest radiography. More recently, chest computed tomography has been helpful in making the diagnosis. Injury to vital structures such as the tracheobronchial tree or esophageal tears require operative fixation. However, in most instances, pneumopericardium is secondary to dissection of air through the adjacent structures to the pericardial space. The air is trapped as a one-way valve. The pneumopericardium is usually self-limited, requiring no specific therapy. In patients where there is a concomitant pneumothorax, chest tube drainage suffices. We present a case of hemodynamically significant tension pneumopericardium that occurred in association with blunt carotid injury and aortic injury.
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Affiliation(s)
- James M. Haan
- From the R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Thomasm Scalea
- From the R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
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Stegmaier J, Kirchhoff C, Biberthaler P, Buhmann S, Körner M, Ladurner R, Kanz KG, Mutschler W. [Tension pneumopericardium--a rare complication in multiply injured patients]. Unfallchirurg 2005; 109:245-50. [PMID: 16270190 DOI: 10.1007/s00113-005-1018-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thoracic injury is a relevant and common complication in multiply injured patients. Typical patterns of injury comprise rib fractures, serious lung trauma as well as diaphragmatic and aortic rupture. In contrast, posttraumatic tension pneumopericardium following blunt thoracic trauma is a very rare complication. However, if unrecognized it might provoke cardiac tamponade and death. For the development of a pneumopericardium, free air follows the vessel bundles up to the pericardium. Hence, if the number of ruptured alveoli is high, or these alveoli are placed close to the heart, and if additional risk factors, such as high inspiratory ventilation pressure, are present, a tension pneumopericardium can induce cardiac tamponade. The aim of this report is to illuminate diagnostic and therapeutic strategies for posttraumatic pneumopericardium by presentation of a case from our trauma centre and a critical discussion of the present literature.
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Affiliation(s)
- J Stegmaier
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilans-Universität, München
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