1
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Martinho M, Brochado L, Pereira H. Answer: Pericardial double trouble. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:639-640. [PMID: 39084647 DOI: 10.1093/ehjacc/zuae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Mariana Martinho
- Cardiology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Liliana Brochado
- Cardiology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
| | - Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Centro Académico Médico de Lisboa, Universidade de Lisboa, Lisboa, Portugal
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2
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Yilmaz M, Gurkan O, Arslanboga EN, Karaca Ozer P. A rare complication of pericardiocentesis: Pneumopericardium. Echocardiography 2023; 40:370-372. [PMID: 36973227 DOI: 10.1111/echo.15555] [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: 02/08/2023] [Revised: 03/23/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Pneumopericardium is the presence of air in the pericardial sac. Pneumopericardium after pericardiocentesis has been rarely reported in the literature. In the present case, we report a patient who presented with tamponade physiology during COVID-19 and developed pneumopericardium after emergency pericardiocentesis. Immediate recognition and treatment are crucial and chest x-ray, thorax computerized tomography, and transthoracic echocardiography (TTE) are used for diagnosis.
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Affiliation(s)
- Mustafa Yilmaz
- Gaziosmanpasa Research and Training Hospital, Cardiology Department, Istanbul, Turkey
| | - Okan Gurkan
- Gaziosmanpasa Research and Training Hospital, Radiology Department, Istanbul, Turkey
| | - Elif Nur Arslanboga
- Gaziosmanpasa Research and Training Hospital, Family Medicine Department, Istanbul, Turkey
| | - Pelin Karaca Ozer
- Istanbul University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
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3
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Triantafyllis AS, Zamfir T, Kontogiannis N. Pneumopericardium as a complication of pericardiocentesis. CMAJ 2023; 195:E193-E194. [PMID: 36746478 PMCID: PMC9904818 DOI: 10.1503/cmaj.221137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Tatiana Zamfir
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
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4
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Ahmed SA, Mohamud MA, Özkurt Y, Abdi IA, Hassan MO. Pneumopericardium with massive pericardial effusion in the setting of tuberculosis constrictive pericarditis: a rare case report. J Surg Case Rep 2022; 2022:rjac380. [PMID: 36003225 PMCID: PMC9393189 DOI: 10.1093/jscr/rjac380] [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] [Received: 06/17/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
Constrictive pericarditis is an uncommon complication of acute pericarditis, mainly caused by non-idiopathic sources. Pneumopericardium is the presence of air in the pericardial sac resulting from various procedures and circumstances, including trauma, iatrogenic, non-iatrogenic and natural causes. Here, we report a 16-year-old girl who came to the cardiology outpatient complaining of weakness, abdominal distention and shortness of breath while lying down and exertion. An echocardiography evaluation revealed a thickened precordium and massive pericardial effusion. Pericardiocentesis was performed for diagnosis and treatment purposes. Despite the patient’s remaining symptomatic and having no improvement following the procedure, we decided to perform chest computed tomography, which revealed a thickened pericardium with pneumopericardium. Partial pericardiectomy was performed successfully, and the sample was sent to the pathology department, which confirmed tuberculous constrictive pericarditis. The patient’s symptoms improved, and she was discharged on postoperative Day 5 standing on her foot.
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Affiliation(s)
- Said Abdirahman Ahmed
- Cardiology Department, Mogadishu Somali-Turkish Training and Research Hospital , Mogadishu , Somalia
| | - Mohamed Abdullah Mohamud
- Cardiology Department, Mogadishu Somali-Turkish Training and Research Hospital , Mogadishu , Somalia
| | - Yalçın Özkurt
- Cardiology Department, Mogadishu Somali-Turkish Training and Research Hospital , Mogadishu , Somalia
| | - Ishak Ahmed Abdi
- Cardiology Department, Mogadishu Somali-Turkish Training and Research Hospital , Mogadishu , Somalia
| | - Mohamed Omar Hassan
- Cardiology Department, Mogadishu Somali-Turkish Training and Research Hospital , Mogadishu , Somalia
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5
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Alonso-Ventura V, Gomollón García JP, Ruiz Aranjuelo A, Álvarez Roy L, Juez Jiménez Á, Miñano Oyarzábal A, Aured Guallar C, Simón Paracuellos T, Solana Hidalgo MP. Hydropneumopericardium: A rare complication of pericardiocentesis. Echocardiography 2021; 39:109-111. [PMID: 34964521 DOI: 10.1111/echo.15251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vanesa Alonso-Ventura
- Departamento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.,Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - Laura Álvarez Roy
- Departamento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ángela Juez Jiménez
- Departamento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Departamento de Cardiología, Hospital Comarcal de Alcañiz, Teruel, Spain
| | | | - Carmen Aured Guallar
- Departamento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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6
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Carmack AE, LaRocco AM, Mathew M, Goldberg HV, Patel DM, Saleeb PG. Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933684. [PMID: 34782592 PMCID: PMC8607027 DOI: 10.12659/ajcr.933684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 34-year-old
Final Diagnosis: Pericarditis
Symptoms: Chest pain • cough • fever • shortness of breath
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases
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Affiliation(s)
- Anna E Carmack
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Allison M LaRocco
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Minu Mathew
- Department of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hannah V Goldberg
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA.,Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Devang M Patel
- Department of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD, USA
| | - Paul G Saleeb
- Department of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD, USA
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7
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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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8
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Vohra S, Pradhan A, Vishwakarma P, Sethi R. Hydropneumopericardium: A rare complication of pericardiocentesis. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:158-160. [PMID: 34825544 DOI: 10.25259/nmji_392_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hydropneumopericardium is defined as the presence of air and water in the pericardial cavity. Several causes have been postulated which can lead to hydropneumopericardium including trauma, infections secondary to gas-producing bacilli, fistula formation, positive pressure ventilation or even spontaneously without an underlying cause in healthy adults and rarely after pericardiocentesis. We report an uncommon instance of hydropneumopericardium after pericardiocentesis in a 35-year-old man, which developed due to a leaky drainage system. It was immediately drained through the subxiphoid approach under echocardiographic guidance, and the patient was relieved. Hydropneumopericardium is an uncommon but easily diagnosable and avoidable complication of pericardiocentesis. It should be suspected whenever the patient develops increasing dyspnoea following a temporary relief by pericardiocentesis.
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Affiliation(s)
- Shweta Vohra
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
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9
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Palma A, Henriques C, Silva PV, Pires A. Pneumopericardium and pleural effusion: a rare complication of paediatric pericardiocentesis. BMJ Case Rep 2020; 13:e236308. [PMID: 33148574 PMCID: PMC7640467 DOI: 10.1136/bcr-2020-236308] [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] [Accepted: 10/18/2020] [Indexed: 11/03/2022] Open
Abstract
Pneumopericardium is a rare complication of pericardiocentesis (PC), occurring as a result of either a direct pleuropericardial communication or a leaky drainage system. Pneumopericardium is often self-limiting; however, physicians should be aware of this complication as it may progress to tension pneumopericardium, which requires immediate recognition and management. PC has been associated with pneumothorax, pneumomediastinum or subcutaneous emphysema, but the association with pleural effusion has been less reported. The authors present the case of a 14-year-old healthy boy who developed post-PC pneumopericardium and pleural effusion, a rare association reported in the literature. The diagnosis of this potential life-threatening event was made using readily available complementary diagnostic methods, such as transthoracic echocardiography and chest X-ray.
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Affiliation(s)
- Andreia Palma
- Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Claudio Henriques
- Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Patrícia Vaz Silva
- Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - António Pires
- Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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10
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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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11
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Shah H, Salahudin M, Altaf A. Asymptomatic Pneumopericardium with Atrial Fibrillation after Pericardiocentesis: A Case Report. J Tehran Heart Cent 2019; 14:134-137. [PMID: 31998390 PMCID: PMC6981340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Air inside the pericardial cavity is called "pneumopericardium", which is a rare complication of pericardiocentesis. Pneumopericardium may resolve spontaneously or can complicate into tension pericardium, requiring urgent aspiration. We herein describe a 55-year-old man with pericardial effusion who underwent pericardiocentesis. The patient was completely asymptomatic after the procedure. Chest radiograph and computed tomography scan accidentally detected pneumopericardium, which was subsequently complicated by atrial fibrillation and necessitated pharmacological cardioversion. We found no case of asymptomatic pneumopericardium complicated by atrial fibrillation after pericardiocentesis in our literature review. Clinicians and cardiologists should do a post pericardiocentesis chest X-ray to diagnose pneumopericardium and prevent the catastrophic complications of tension pneumopericardium.
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Affiliation(s)
- Hammad Shah
- Corresponding Author: Hammad Shah, Department of Cardiology, Rehman Medical Institute, Sector 5-B/II, Peshawar, Pakistan. Tel: +96 612520088. Fax: +96 612520718.E-mail: .
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12
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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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13
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Abstract
A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.
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14
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Pneumopericardium Following Pericardiocentesis. Am J Med 2016; 129:e181-2. [PMID: 27107923 DOI: 10.1016/j.amjmed.2016.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 11/22/2022]
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15
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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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16
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Cho SH, Hwang HJ, Park CB. Pneumopericardium after pericardiostomy. J Formos Med Assoc 2016; 115:816-7. [PMID: 27117885 DOI: 10.1016/j.jfma.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/21/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
| | - Hui-Jeong Hwang
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Bum Park
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea.
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17
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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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18
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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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19
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Kumar R, Sinha A, Lin MJ, Uchino R, Butryn T, O'Mara MS, Nanda S, Shirani J, Stawicki SP. Complications of pericardiocentesis: A clinical synopsis. Int J Crit Illn Inj Sci 2015; 5:206-12. [PMID: 26557491 PMCID: PMC4613420 DOI: 10.4103/2229-5151.165007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure.
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Affiliation(s)
- Rajan Kumar
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Archana Sinha
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Maggie J Lin
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Reina Uchino
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Tracy Butryn
- Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - M Shay O'Mara
- Department of Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, United States
| | - Sudip Nanda
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
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20
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Park YK, Jung HC, Kim SY, Kim MY, Jo K, Kim SY, Kang B, Woo G, Choi HJ, Wie SH. Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia. Infect Chemother 2014; 46:204-8. [PMID: 25298911 PMCID: PMC4189138 DOI: 10.3947/ic.2014.46.3.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 11/24/2022] Open
Abstract
Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.
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Affiliation(s)
- Yun Kyung Park
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hee Chan Jung
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Shin Young Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Min Young Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Kwanhoon Jo
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Se Young Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Borami Kang
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Gihyeon Woo
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hyun Joo Choi
- Department of Pathology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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21
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An unexpected outcome after pericardiocentesis. Intensive Care Med 2013; 39:1845-6. [PMID: 23907499 DOI: 10.1007/s00134-013-3048-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
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22
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Abstract
Cardiovascular disease remains a leading cause of hospitalization and mortality worldwide. Conventional heart failure treatment is making steady and substantial progress to reduce the burden of disease. Nevertheless novel therapies and especially cardiac gene therapy have been emerging in the past and successfully made their way into first clinical trials. Gene therapy was initially a visionary treatment strategy for inherited, monogenetic diseases but has now developed to have potential for polygenic diseases as atherosclerosis, arrhythmias and heart failure. These novel therapeutic strategies require testing in clinically relevant animal models to transition from 'bench to bedside'. One of the major hurdles for effective cardiovascular gene therapy is the delivery of the viral vectors to the heart. In this review we present the currently available vector-mediated cardiac gene delivery methods in vivo considering the specific merits and deficiencies.
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