Pneumopericardium as complication of COVID-19

Abstract

The source of gas or air collection in the pericardial sac varies depending on the etiology and can result through one of the following: fistulization between the pericardial sac and an external source of air from neighboring air-containing organs (trachea, bronchi or gastrointestinal tract); tracking of air along pulmonary venous perivascular sheath from accompanying pneumomediastinum through the pericardial reflection; or an infectious process from within with a gas producing microorganism as the case in acute pericarditis. However, the majority of pneumopericardium cases results from an induced increase in the intrathoracic pressure that introduces air into the pericardial space from the tracheobronchial tree which can occur but not limited to the following conditions: blunt or penetrating trauma to the chest, chest surgery, severe obstructive airway disease, or positive pressure ventilation as in patient with COVID-19 developing adult respiratory distress syndrome (ARDS). Depending on the precipitating factors and etiology along with the amount and speed of air accumulation in the pericardial sac, pneumopericardium can be presented as simple or tension pneumopericardium