Pneumopericardium and pneumomediastinum: rate complications of pneumoencephalography

Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review

In pneumopericardium, a rare but potentially life threatening differential diagnosis of chest pain with a broad variety of causes, rapid diagnosis and adequate treatment are crucial. In upright posteroanterior chest radiography, the apical limit of a radiolucent rim, outlining both the left ventricle and the right atrium, lies at the level of the pulmonary artery and ascending aorta, reflecting the anatomical limits of the pericardium. The band of gas surrounding the heart may outline the normally invisible parts of the diaphragm, producing the continuous left hemidiaphragm sign in an upright lateral chest radiograph. If haemodynamic conditions are stable, the underlying condition should be treated and the patient should be monitored closely. Acute haemodynamic deterioration should prompt rapid further investigation and cardiac tamponade must be actively ruled out. Spontaneous pneumopericardium in a 20 year old man is presented, and its pathophysiology described.

Pneumomediastinum caused by subcutaneous emphysema in the shoulder. A rare complication of arthroscopy

Severe subcutaneous emphysema following arthroscopy of the shoulder developed in a 62-year-old man. It subsequently evolved into pneumomediastinum with respiratory distress, but the patient recovered spontaneously. To our knowledge, this constitutes the first report of pneumomediastinum caused by subcutaneous emphysema in the shoulder.

Traumatic tension pneumopericardium: a case report and literature review

A 39-year-old male arrived in the emergency department with multiple stab wounds to the chest. A pneumopericardium was present on initial chest x-ray study. He subsequently developed hypotension, tachycardia, an elevated CVP (36 cm H2O) and a pulsus paradoxus. All parameters improved following removal of 100 cc of air by pericardiocentesis. The etiology, diagnosis, pathophysiology, and treatment of tension pneumopericardium are discussed.