PNEUMOPERICARDIUM: UNEXPECTED FINDING IN A BLUNT THORACIC TRAUMA

Abstract

TYPE: Late Breaking Abstract TOPIC: Critical Care INTRODUCTION: Pneumopericardium is a rare finding. We present a clinical case of a pneumopericardium due to blunt thoracic trauma and its management. CASE PRESENTATION: A 22-year male admitted to the Emergency Department after a high energy car crash with blunt thoracic and abdominal trauma presented with severe hypotension and tachycardia. Thoracic x-ray showed a left pneumothorax and a chest tube was inserted. FAST ultrasound was positive on the Morrison space, prompting immediate surgical intervention, during which a right chest tube was inserted due to suspicion of right pneumothorax. After surgery, the patient remained in circulatory shock, warranting high doses of vasoactive drugs. A CT scan was performed, depicting a 15 mm pneumopericardium (Figure 1). ECG had a low voltage tracing, a mild elevation of cardiac biomarkers was noted and echocardiography showed preserved biventricular systolic function, a 10 mm inferior vena cava and no signs of cardiac compression, thus making tension pneumopericardium an unlikely diagnosis. The right chest drain was hypothesized as potential cause of the pneumopericardium. An urgent consultation with cardiac surgery was requested and low pressure suction was initiated in the ICU. Pneumopericardium dimensions improved over time, with no evidence of pericardial air on day three. DISCUSSION: Although its etiology remained unclear, close monitoring for signs of cardiac suffering throughout ICU stay and a conservative approach led to clinical resolution. CONCLUSIONS: This case highlights the need for a multidisciplinary approach when managing specific thoracic pathology in the ICU setting. DISCLOSURE: No significant relationships. KEYWORD: pneumopericardium