Asymptomatic Spontaneous Pneumopericardium, Pneumomediastinum, and Subcutaneous Emphysema: A Case Report of an Incidental Rare Presentation.

Mrhaf Alsamman,Sandi Dunn,Alan Hamza,Shaye Busse

doi:10.7759/cureus.20464

Abstract

Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. They are normally self-limited unless tension pneumothorax, tension PM, cardiac herniation, air tamponade, and esophageal rupture accompany these disorders. PM and PP can be divided into “spontaneous” or “secondary” based on the preceding etiologies. Spontaneous PM is often extremely rare and benign in course. On the other hand, secondary PM and PP are more common and result from intrathoracic infections, trauma-related esophageal rupture, or tears along the tracheobronchial tree. Our patient presented four days after a fall from a chair and was found to have suffered a stroke, with complete left side paralysis. CT imaging on arrival was significant for PM, PP, and SE, the cause of which remains unclear. The patient was diagnosed with COVID-pneumonia approximately six months prior to presentation. As the COVID-19 pandemic has evolved, several scientific papers have been published reporting infected patients who had developed spontaneous PT, PM, or even PP, in the absence of invasive mechanical ventilation. Is it possible that the spontaneous findings in our patient were COVID-related? Or could the spontaneous PP, PM, and SE be a sequel to the trauma of her fall from a chair? The answer still remains unclear.

Highlights

Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. They are normally self-limited unless tension pneumothorax, tension PM, cardiac herniation and air tamponade, and esophageal rupture accompany these disorders [1]
We present a case of a 74-year-old female who presented to our facility for left-sided weakness secondary to a stroke and was found to have PP, PM, and SE
PP, PM, and SE all refer to the presence of free air in the pericardial cavity, mediastinum, and the subcutaneous tissues of the skin, respectively

Summary

Introduction

Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. A 74-year-old female presented to an outside emergency department after a fall from a chair four days earlier and subsequent persistent weakness Her past medical history is significant for atrial fibrillation not being treated with anticoagulant medications, hypertension, hyperlipidemia, congestive heart failure, type 2 diabetes, and having COVID-19 six months prior, fully vaccinated. The patient had a CT of the brain which showed no acute findings, and a chest CT that showed PP, PM, and SE of the neck and chest. A cardiac exam was notable for atrial fibrillation with a rapid ventricular response Her left lower extremity was erythematous, tender to palpation, had 2+ pitting edema, and had abrasions along the lateral aspect. There was no further imaging of the chest done during or after this hospital stay, which would have provided adequate visualization for monitoring of the patient’s asymptomatic PP, PM, and SE

Discussion

Conclusions

Disclosures

10. Uluçam MZ