Pneumopericardium

Abstract

A 27-year-old man was admitted to the hospital after a fall from approximately 10 m. He had multiple bone fractures, head trauma (Glasgow Coma Scale: 4/15), bilateral pulmonary contusions and pneumothoraces. We placed bilateral tube thoracostomies, and treated his other injuries. 1 day later, because of severe haemodynamic instability (hypotension and low cardiac output with high central venous pressure), we did transoesophageal echocardiography and found right ventricular compression in the absence of a pericardial effusion. Repeat chest radiographs (figure, left) showed the existing bilateral lung contusions and a new lucent outline of the heart (arrows). Computed tomography of the chest confirmed the diagnosis of post-traumatic pneumopericardium (figure, right, black arrow), bilateral pneumothoraces (white arrows) and lung contusion. The pneumopericardium resolved after we repositioned the left-sided interthoracic tube. A 27-year-old man was admitted to the hospital after a fall from approximately 10 m. He had multiple bone fractures, head trauma (Glasgow Coma Scale: 4/15), bilateral pulmonary contusions and pneumothoraces. We placed bilateral tube thoracostomies, and treated his other injuries. 1 day later, because of severe haemodynamic instability (hypotension and low cardiac output with high central venous pressure), we did transoesophageal echocardiography and found right ventricular compression in the absence of a pericardial effusion. Repeat chest radiographs (figure, left) showed the existing bilateral lung contusions and a new lucent outline of the heart (arrows). Computed tomography of the chest confirmed the diagnosis of post-traumatic pneumopericardium (figure, right, black arrow), bilateral pneumothoraces (white arrows) and lung contusion. The pneumopericardium resolved after we repositioned the left-sided interthoracic tube.