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Pneumopericardium: A Rare Complication of Pericardiocentesis

  • Iskander, Slama (Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps) ;
  • Amar, Hidoud (Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps) ;
  • Audrey, Boudes (Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps) ;
  • Fabien, Devemy (Department of Cardiology, Clinical Echocardiography Laboratory, Intercommunity Hospital of Southern Alps)
  • Received : 2015.06.17
  • Accepted : 2016.02.01
  • Published : 2016.03.27

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.

Keywords

References

  1. Lee YJ, Jin SW, Jang SH, Jang YS, Lee EK, Kim YJ, Lee MY, Park JC, Rho TH, Kim JH, Hong SJ, Choi KB. A case of spontaneous pneumomediastinum and pneumopericardium in a young adult. Korean J Intern Med 2001;16:205-9. https://doi.org/10.3904/kjim.2001.16.3.205
  2. Mullens W, Dupont M, De Raedt H. Pneumopericardium after pericardiocentesis. Int J Cardiol 2007;118:e57. https://doi.org/10.1016/j.ijcard.2006.12.082
  3. Choi WH, Hwang YM, Park MY, Lee SJ, Lee HY, Kim SW, Jun BY, Min JS, Shin WS, Lee JM, Koh YS, Jeon HK, Chung WS, Seung KB. Pneumopericardium as a complication of pericardiocentesis. Korean Circ J 2011;41:280-2. https://doi.org/10.4070/kcj.2011.41.5.280
  4. Brander L, Ramsay D, Dreier D, Peter M, Graeni R. Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review. Heart 2002;88:e5. https://doi.org/10.1136/heart.88.4.e5
  5. Yuce M, Sari I, Davutoglu V, Ozer O, Usalan C. Bubbles around the heart: pneumopericardium 10 days after pericardiocentesis. Echocardiography 2010;27:E115-6. https://doi.org/10.1111/j.1540-8175.2010.01245.x
  6. Lee SH, Kim WH, Lee SR, Rhee KS, Chae JK, Ko JK. Cardiac tamponade by iatrogenic pneumopericardium. J Cardiovasc Ultrasound 2008;16:26-8. https://doi.org/10.4250/jcu.2008.16.1.26
  7. Rashid MA, Wikström T, Ortenwall P. Pneumopericardium and pneumoperitoneum after penetrating chest injury. Eur J Surg 1999;165:278-9. https://doi.org/10.1080/110241599750007199
  8. Muller AM, Betz MJ, Kromeier J, Ghanem NA, Geibel A, Imdahl A, Frydrychowicz AP. Images in cardiovascular medicine. Acute pneumopericardium due to intestino-pericardial fistula. Circulation 2006;114:e7-9. https://doi.org/10.1161/CIRCULATIONAHA.105.601252
  9. Shackelford RT. Hydropneumopericardium: report of a case with a summary of the literature. JAMA 1931;96:187-91. https://doi.org/10.1001/jama.1931.02720290031008
  10. Cummings RG, Wesly RL, Adams DH, Lowe JE. Pneumopericardium resulting in cardiac tamponade. Ann Thorac Surg 1984;37:511-8. https://doi.org/10.1016/S0003-4975(10)61146-0
  11. Marijon E, Jani D, Aubert S. Unusual chest radiograph after surgical pericardiotomy. Tex Heart Inst J 2007;34:256-7.
  12. Bejvan SM, Godwin JD. Pneumomediastinum: old signs and new signs. AJR Am J Roentgenol 1996;166:1041-8. https://doi.org/10.2214/ajr.166.5.8615238
  13. Reid CL, Chandraratna AN, Kawanishi D, Bezdek WD, Schatz R, Nanna M, Rahimtoola SH. Echocardiographic detection of pneumomediastinum and pneumopericardium: the air gap sign. J Am Coll Cardiol 1983;1:916-21. https://doi.org/10.1016/S0735-1097(83)80209-5
  14. Kerut EK, Hannawalt C, Everson CT, Nanda NC. The air gap sign. Echocardiography 2014;31:400-1. https://doi.org/10.1111/echo.12513
  15. Antonini-Canterin F, Nicolosi GL, Mascitelli L, Zanuttini D. Direct demonstration of an air-fluid interface by two-dimensional echocardiography: a new diagnostic sign of hydropneumopericardium. J Am Soc Echocardiogr 1996;9:187-9. https://doi.org/10.1016/S0894-7317(96)90027-9
  16. Uluçam MZ. An extremely rare combination: pneumopericardium, pneumoperitoneum, and subcutanous emphysema-a case report. Cardiol Ther 2013;2:103-10. https://doi.org/10.1007/s40119-012-0008-6
  17. Ozerkan F, Bilgin M, Oktem MS, Alkan MB. [Pneumopericardium after pericardiocentesis: a case report]. Turk Kardiyol Dern Ars 2011;39:697-700. https://doi.org/10.5543/tkda.2011.01699
  18. Wacker W, Merrill JP. Uremic pericarditis in acute and chronic renal failure. J Am Med Assoc 1954;156:764-5. https://doi.org/10.1001/jama.1954.02950080012005
  19. Rostand SG, Rutsky EA. Pericarditis in end-stage renal disease. Cardiol Clin 1990;8:701-7. https://doi.org/10.1016/S0733-8651(18)30342-4

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