Spontaneous Pneumopericardium Research Articles

Spontaneous pneumomediastinum and pneumopericardium in a young woman: a case report

Spontaneous pneumomediastinum and pneumopericardium in a young woman: a case report

Recurrent thoracic air leak syndrome in patients affected by pulmonary graft-versus-host disease: Surgical strategies and outcome.

Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome. We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome. In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak. Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.

Spontaneous pneumomediastinum and pneumopericardium in a young female: a case report

Spontaneous pneumomediastinum and pneumopericardium in a young female: a case report

A VERY RARE CASE OF ISOLATED SPONTANEOUS PNEUMOPERICARDIUM SECONDARY TO COVID-19

TYPE: Case Report TOPIC: Cardiovascular Disease INTRODUCTION: During the COVID-19 pandemic, new and atypical clinical manifestations and complications of this disease continue to emerge. One of these rare complications is spontaneous pneumopericardium. CASE PRESENTATION: A 75-year-old male presented to our hospital with fever, productive cough, and fatigue for 3 days. Physical exam demonstrated crackles at the right and left lung bases. Nasopharyngeal severe acute respiratory syndrome coronavirus 2(SARS-C0V-2) reverse transcriptase-polymerase chain reaction was positive. A chest CT scan was ordered and demonstrated pneumopericardium without subcutaneous emphysema, pneumomediastinum or pneumothorax. On day seven of hospitalization, he had acutely increased work of breathing and had desaturations. He was intubated. Two days later the patient died of severe respiratory insufficiency. DISCUSSION: The most common causes of pneumopericardium are chest trauma, mechanical ventilation, and cardiothoracic operations. After alveolar damage, air enters interstitial tissue spaces or continue dissecting along with the perivascular and peribronchial connective tissue. In COVID-19, alveolar rupture, hyperinflammatory response and hypercoagulability, could increase the risk of pneumopericardium, and pneumomediastinum. Alveolar rupture and inflammation in the setting of COVID-19 could have resulted in the fistulous communication between the lung and pericardium leading to isolated pneumopericardium in this patient. Most patients with pneumopericardium remain asymptomatic but can sometimes develop the complication of tension pneumopericardium leading to hemodynamic instability. Pneumopericardium is usually a self-limiting condition and is managed conservatively. CONCLUSIONS: It is very important that clinicians must be aware of this rare but potentially fatal complication of COVID-19. Further studies are needed to establish the association between the presence of spontaneous pneumopericardium and outcomes in COVID-19. DISCLOSURE: Nothing to declare. KEYWORD: pneumopericardium

Simultaneous Occurrence of Pneumomediastinum, Pneumopericardium and Surgical Emphysema in a Patient of COVID-19: A Case Report

As we enter the third year of the COVID pandemic, the SARS-CoV-2 virus keeps on surprising clinicians globally with atypical manifestations. Spontaneous pneumomediastinum is the accumulation of free air within the mediastinum without any preceding trauma or invasive procedure. Pneumomediastinum has been recently reported in the literature, often with associated mortality and morbidity in COVID-19 patients exposed to positive pressure ventilation due to barotrauma. We report the case of a 47-year-old man admitted for management of infection by the SARS-CoV-2. After one week of in-patient treatment, the patient still had worsening dyspnea. Repeat chest X-ray revealed surgical emphysema in neck and NCCT chest revealed pneumomediastinum and pneumopericardium. The spontaneous pneumomediastinum and pneumopericardium with surgical emphysema resorbed over 22 days with a favourable clinical outcome without any invasive intervention. Patient was discharged subsequently with vitals maintaining on room air. A keen clinical observation and timely imaging study can help in detecting these complications early and direct the management accordingly.

Spontaneous Pneumopericardium in a Term Newborn

We present the case of a term newborn who developed cardiopulmonary distress at 15 minutes of age secondary to a spontaneous pneumopericardium. Diagnostic and therapeutic considerations are addressed.

SPONTANEOUS TENSION PNEUMOMEDIASTINUM: MANAGEMENT IN PNEUMOCYSTIS JIROVECI PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous secondary pneumothorax has been reported in up to 35% of patients with Pneumocystis jirovecii (PCJ) pneumonia with human immunodeficiency virus (HIV), however, associated with bilateral pneumothorax and pneumomediastinum is a rare life-threatening condition. We present an interesting case of non-surgical management of spontaneous bilateral pneumothorax with tension pneumomediastinum in an immunocompromised individual with mediastinal drain and large-bore chest tube at the bedside with significant improvement in symptoms and hemodynamic improvement. CASE PRESENTATION: 54 years old non-compliant with his medicines with a history of HIV, type II diabetes mellitus came with complaints of dyspnea on exertion, non-productive cough for 2-3 weeks. On admission, he was afebrile, tachypneic, tachycardiac with bilateral coarse breath sounds on physical exam. Chest x-ray on admission showed bilateral multifocal opacities without any pleural effusion or pneumothorax and initial laboratory results were unremarkable. He developed spontaneous subcutaneous emphysema with crepitus extending up to his neck and face three days into hospitalization. Computed Tomography (CT) chest showed bilateral ground-glass opacities, bilateral pneumothorax, and extensive pneumomediastinum along the neck with mass effect on the heart. Initially, bilateral chest tubes were placed with improvement in pneumothoraces but persistent air leaks. One week later, he had worsening pneumomediastinum with acute hypoxic respiratory failure and obstructive shock requiring mechanical ventilation. An emergent 8 Fr mediastinal drain was placed by the ICU team at the bedside under fluoroscopy guidance with improvement in his hemodynamic status. Bronchoscopy with bronchoalveolar lavage showed PCJ DNA on PCR. His symptoms resolved over the course of hospitalization and he was discharged home on room air after a prolonged hospitalization on Biktarvy® and trimethoprim-sulfamethoxazole. DISCUSSION: PCJ pneumonia should be considered as a cause of pulmonary infection in HIV patients, subcutaneous emphysema leading to pneumothorax and pneumomediastinum has been reported with high mortality rates. Spontaneous pneumothorax develops secondary to cyst or bleb rupture due to PCJ pneumonia. Spontaneous pneumomediastinum may occur due to an abrupt increase in the trans-alveolar pressure gradient due to infections, trauma, violent coughing, or can be iatrogenic; however, tension pneumomediastinum is extremely rare. In this case, urgent treatment of pneumomediastinum at the bedside with early treatment initiation for PCP without BAL results was a life-saving measure. CONCLUSIONS: Early recognition of symptoms in immunocompromised individuals, point-of-care ultrasound, and bedside procedures in an emergent setting in non-surgical candidates in the ICU are life-saving measures with prompt anti-microbial therapy for successful treatment. REFERENCE #1: Park YK, Jung HC, Kim SY, et al. Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia. Infect Chemother. 2014;46(3):204-208. doi:10.3947/ic.2014.46.3.204 REFERENCE #2: Yee D, Fu D, Hui C, Dharmadhikari N, Carino G. A Rare Case of 4 Ps: Bilateral Pneumothoraces and Pneumomediastinum in Pneumocystis Pneumonia. R I Med J (2013). 2020 Jun 1;103(5):52-54. PMID: 32481782 REFERENCE #3: Saleem N, Parveen S, Odigwe C, Iroegbu N. Pneumomediastinum, pneumorrhachis, and subcutaneous emphysema in Pneumocystis jiroveci pneumonia in AIDS. Proc (Bayl Univ Med Cent). 2016;29(2):188-190. doi:10.1080/08998280.2016.11929412 DISCLOSURES: No relevant relationships by Mahnoor Mir, source=Web Response No relevant relationships by Jay Peters, source=Web Response No relevant relationships by Jorge Villalpando, source=Web Response

Pneumomediastinum, pneumopericardium, and subcutaneous emphysema\u2014a rare complication in COVID-19 infection

BackgroundCoronavirus disease 2019 (COVID-19) has become a global pandemic and is posing a serious public health problem for almost all countries. Spontaneous pneumomediastinum, a rare condition, is usually seen in patients with underlying pulmonary pathology, infections, or mechanical ventilation. Spontaneous pneumomediastinum is a rare complication in COVID-19 pneumonia.Case presentationWe report a case of spontaneous pneumomediastinum, pneumopericardium, and subcutaneous emphysema in a 62-year-old diabetic patient with COVID-19 infection who presented with cough, fever, and breathlessness, which turned to be a fatal complication.ConclusionPneumomediastinum/subcutaneous emphysema, a not so common complication associated with COVID-19 infection, should be considered as a bad prognostic indicator of worsening disease and hence requires early recognition and careful monitoring of the patient for any possible unfavorable outcome.

Neumomediastino y neumopericardio espontáneo en paciente con COVID-19; reporte de caso

Introducción: El neumomediastino y neumopericardio espontáneo en pacientes con COVID-19 pueden presentarse de manera inusual, y causar una evolución clínica tórpida. Presentamos el primer reporte clínico del Paraguay de una paciente con neumomediastino y neumopericardio asociado a neumonía por COVID-19.

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema-Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection-A Series of Cases.

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

Spontaneous pneumomediastinum and pneumopericardium in a child with severe diabetic ketoacidosis: A case report

Apart from being the most common endocrine emergency in the pediatric intensive care unit, some clinical manifestations of diabetic ketoacidosis such as vomiting and continued acidotic breathing may, on the rare occasion, lead to unexpected complications such as pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The differentials for the same include Hamman's syndrome secondary to forceful coughing or Valsalva maneuver, Boerhaave syndrome resulting from forceful vomiting, and even spontaneous air leaks due to severe swings in intrathoracic pressure during Kussmaul breathing, leading to alveolar rupture causing air leak. These complications may have subtle signs as well as a significant overlap in presentation and require a high index of suspicion to diagnose and careful evaluation to differentiate. We hereby report a 3-year-old child with new-onset type 1 diabetes mellitus in severe DKA, leading to pneumomediastinum and pneumopericardium where computed tomography of the thorax helped rule out differentials and the air leak resolved spontaneously with the resolution of acidosis.

Spontaneous massive pneumopericardium in a patient with COVID-19.

Spontaneous massive pneumopericardium in a patient with COVID-19.

Spontaneous pneumopericardium in a patient with lung cancer.

Spontaneous pneumopericardium in a patient with lung cancer.

Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

BackgroundSpontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon.Case presentationWe present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage.ConclusionsSpontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.

SPONTANEOUS PNEUMOPERICARDIUM: A CASE REPORT OF AN UNUSUAL AND A RARE PRESENTATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous pneumopericardium is defined as the presence of free air in the pericardial sac without apparent precipitating cause. It is more common in young adults without pre-existing pulmonary disease (1). Although often asymptomatic, it can cause chest pain and shortness of breath. Progression of this condition into Tamponade can be life-threatening. We describe the case of a 21-year-old female who presented with shortness of breath and was incidentally found to have pneumopericardium. CASE PRESENTATION: A 21-year-old female with obstructive sleep apnea and asthma presented with cough with blood-tinged sputum production and shortness of breath for 3 days. On examination, she was tachypneic, had muffled heart sounds and bilateral wheezes. A chest x-ray showed pneumomediastinum along with pneumopericardium (figure 1). EKG without evidence of ischemic changes or tamponade. A CT scan of the chest was done that showed pneumopericardium with pneumomediastinum and extensive soft tissue gas insulating to the deep fascial planes of the neck and upper chest (figure 2 & 3). There were no signs of esophageal rupture. She was initially treated with broad-spectrum antibiotics and intravenous steroids. Antibiotics were later stopped as no infectious etiology was found. The patient remained hemodynamically stable throughout the hospital course. Repeated chest x-ray imaging on day 2 showed improving pneumopericardium and pneumomediastinum. She was eventually discharged from hospital and imaging during her office follow-up showed complete resolution of the pneumopericardium and pneumomediastinum (figure 4). DISCUSSION: Spontaneous pneumopericardium is rare. Common causes include trauma- secondary to perforation of the pericardium, infection by a gas-forming organism, viscus perforation such as the esophagus, stomach, liver abscess, iatrogenic. ‘’Macklin effect’’ describes the mechanism of air collection in the mediastinum. The increased pressure gradient between the alveoli and the interstitial space leads to the rupture of the alveolar structure resulting in air leakage. A tinkling sound superimposed over a succession splash can be heard, as a result, called “Bruit de Moulin”, which is French for “Millwheel murmur”.(2) Symptoms include dyspnea, precordial chest discomfort, upper abdominal pain or syncope. Physical examination may be absent or may include subcutaneous emphysema, Hamman sign, Millwheel murmur or Beck’s triad (if Tamponade develops). CONCLUSIONS: All the patients should be admitted to the hospital and should be monitored. The initial therapy should be targeted at underlying disease processes. Supplemental oxygen will enhance the reabsorption of the free air by increasing the gradient of nitrogen between the alveoli and the tissues. Symptoms typically resolve within 24-48 hours and follow up CXR should be done to look at progression/resolution or for the complications. (1) Reference #1: Young-Jung Lee, M.D., Seung-Won Jin, M.D., Sung-Hee Jang, M.D., Yi-Sun Jang, M.D., Eun-Kyoung Lee, M.D., Yong-Joo Kim, M.D., Man-Young Lee, M.D., Jun-Chul Park, M.D., Tai-Ho Rho, M.D., Jae-Hyung Kim, M.D., Soon-Jo Hong, M.D., and Kyu-Bo Choi, M.D. A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Young Adult. Korean J Intern Med. 2001 Sep; 16(3): 205–209. Reference #2: R S Baum, T G Welch, and A L Bryson. Spontaneous pneumopericardium. West J Med. 1976 Aug; 125(2): 154–156. DISCLOSURES: No relevant relationships by NIRAJAN ADHIKARI, source=Web Response No relevant relationships by Subash Ghimire, source=Web Response

Spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a case of interstitial pneumonia with autoimmune features

Spontaneous Pneumomediastinum (SPM) is a benign, self-limiting but potentially fatal condition specially in underlying pulmonary disease. Spontaneous pneumomediastinum is rarely associated with connective tissue related interstitial lung disease. We report a patient of interstitial pneumonia with autoimmune features who presented with acute onset breathlessness and was diagnosed to have spontaneous pneumomediastinum, pneumopericardium, and subcutaneous emphysema. This condition are easily diagnosed by clinical findings like Hamman's crunch and plain chest radiographs in cases with normal underlying lungs. In cases of extensive pulmonary fibrosis like Interstitial Lung Diseases both clinical findings and Plain chest radiographs can be inconclusive. CT of thorax is the gold standard diagnostic modality. Pneumopericardium rarely leads to cardiac tamponade, which requires immediate surgical intervention. We conclude that every case of acute onset breathlessness in a known case of interstitial lung disease may not necessarily be an exacerbation of the underlying lung condition. Physicians need to have a high index of suspicion while treating patients of interstitial lung disease. CT thorax is gold standard diagnostic modality especially in presence of fibrotic lung diseases.

Pneumopericardium after Foreign Body Aspiration: A Case Report

A case of spontaneous pneumopericardium occurred in the patient after the aspiration of no sharp foreign body. The patient was sent to Operation Theater (OT), bronchoscopic extraction of the foreign body was performed, and the patient was stable postoperatively. Serial follow up X-rayswere done and showed resolving of the pneumopericardium.

Respiratory Distress after a Liver Surgery, Think at Pneumopericardium

Introduction: Pneumopericardium is defined as a collection of air or gas in the pericardium, and considered a rare and innocuous condition. It may progress to tension and cardiac tamponade and may become life-threatening in many instances. In this publication, we will share the case of a pneumopericardium which occurred for middle-aged women treated for liver carcinoma after a laparotomic surgery. Discussion: Pneumopericardium was once defined as a collection of air or gas in the pericardium, and considered a rare and innocuous condition. The most common etiology of pneumopericardium is blunt trauma. Also, air may dissect into the mediastinum from the retroperitoneal space following the perforation of a hollow viscous or infection with gas-producing organisms. Other causes of pneumopericardium include iatrogenic complications during chest or abdominal surgeries. Diagnosis of spontaneous pneumopericardium can often be made with a formal two-view Chest X-Ray or CT scan. The treatment of air in the pericardial space depends on the type of pneumopericardium present and whether or not there is associated cardiac tamponade. However, tension pneumopericardium can be effectively relieved by pericardiocentesis or tube decompression and the underlying cause subsequently determined. Conclusion: In conclusion, surgeons should be aware of the possibility of pneumopericardium for patients with chest pain after a laparoscopic procedure and look for electrocardiographic abnormalities. It is important to outline the important role of the chest CT scan to search for pneumothorax or pneumomediastinum.

ATYPICAL COCAINE USE: A RARE CASE CAUSING PNEUMOPERICARDIUM WITHOUT FISTULA AND PNEUMOMEDIASTENIUM

Pneumopericardium is a procedural complication. In rare occasions is seen when cocaine abusers have a partner apply positive ventilator pressure by direct mouth-to-mouth contact with the purpose to enhance the drug effect, which can cause spontaneous pneumopericardium. 49 y/o female presenting with

Spontaneous Pneumopericardium in a Patient of Lymphangioleiomyomatosis and Pulmonary Tuberculosis- Rare Case Report

Pneumopericardium is a rare entity and is usually reported as a complication of trauma [1].We are reporting a rare case of Lymphangioleiomyomatosis (LAM) coexisting with sputum positive miliary tuberculosis presenting with pneumopericardium. LAM is a rare lung disease of unknown etiology, exclusively affecting women of reproductive age group and is characterised by proliferation and infiltration of pulmonary interstitium with atypical smooth muscle cell. LAM causes pleural complications especially pneumothorax and chylothorax, but it has not been reported to cause pneumopericardium. However pulmonary tuberculosis is known to cause pneumopericardium but coexistence of LAM with Pulmonary tuberculosis is a rare presentation.