Tension pneumopericardium leads to cardiac tamponade during hand-assisted ventilation in patients with uremia

Abstract

Tension pneumopericardium is a rare disease and may indeed be life threatening. It usually occurs in patients receiving assisted ventilation. We report a case of tension pneumopericardium in a patient during computer tomographic scanning. The CT scanning provides us with the necessary images during the development of tension pneumopericardium. Clinical Summary A 62-year-old female patient with a diagnosis of chronic renal insufficiency, uremia, renal anemia, and renal hypertension was admitted to the First Affiliated Hospital, School of Medicine, Zhejiand University on May 1, 2006. At 6 PM on May 6, the patient experienced palpitations after continuous renal replacement therapy was performed, and an atrial fibrillation was observed. After the administration of 5 mg of diltiazem, the patient’s heart rate decreased and returned to sinus rhythm. At 1:30 AM on May 7, the patient began to cough blood sputum and showed chest distress and tachypnea. The life monitor showed a molecular oxygen saturation of 85% to 92%, and moist rales were heard in both sides of the lung. The patient was transferred to the intensive care unit for further observation and management. Shortly afterward, the patient was intubated with mechanical ventilation support. On May 15, the intubated patient underwent a chest computed tomography (CT) scan with hand-assisted ventilation through an Ambu bag. During the examination, the patent’s pulse oxygen saturation decreased dramatically and heart rate decreased gradually. Subcutaneous emphysema developed from the chest to the neck. The CT scan revealed that rightsided pneumothorax,pneumomediastinum, andtensionpneumopericardium were developing (Figures 1 and 2). Two 16-gauge cannulas were punctured into both sides of the patient’s chest, and compelled air was released from the right side of the chest. Epinephrin was injected intravenously, and chest compression was performed; the patient’s heart rate, blood pressure, and oxygen saturation continued to decrease. Ventricular fibrillation occurred, and lidocaine was not effective. Percutaneous pericardiocentesis via the subxiphoid route was performed by the cardiac surgeon later. The patient’s response was observed, but her pupils were diffused. The patient was returned to the intensive care unit after resuscitation, but she never regained consciousness. Six hours later, the patient’s condition worsened; the cardiopulmonary resuscitation procedure and further attempts were unsuccessful. Permission for autopsy was denied.