Pneumopericardium:two case reports and a review

Abstract

Pneumopericardium, and especially tension pneumopericardium, are relatively rare consequences of penetrating, blunt or iatrogenic injury. Despite its rarity and the compressibility of air, pneumopericardium can result in life threatening cardiac tamponade. We present two recent cases of this rare condition with divergent aetiologies from which lessons can be learned. The pathophysiology, diagnosis and treatment of pneumopericardium are reviewed.

Pneumopericardium as a complication of laparoscopy for ovariectomy

“…Another cause of pneumomediastinum has been related to a Veress needle introduced too deeply into the abdominal cavity resulting in pneumoretroperitoneum and passage of CO 2 through the aortic and oesophageal hiatus (Cunningham 1998 ). Clinical signs of a tension pneumopericardium reported in the literature are consistent with the anaesthetic changes in this case, including diminished heart sounds and bradycardia (Visser et al 2008 ). Cardiac tamponade has been reported as a complication of human laparoscopic procedures in patients with traumatic stab injuries to the thorax (Howells et al 2000 ).…”

“…Clinical signs of a tension pneumopericardium reported in the literature are consistent with the anaesthetic changes in this case, including diminished heart sounds and bradycardia (Visser et al . ). Cardiac tamponade has been reported as a complication of human laparoscopic procedures in patients with traumatic stab injuries to the thorax (Howells et al .…”

Perioperative management of pneumopericardium

“…Macroperforations may result from blunt trauma where the airways come into contact with the pericardium, iatrogenic trauma e.g. chest drain insertion or endoscopy and by medical conditions such as intra-abdominal sepsis where gas fistulates between the gastrointestinal system and the pericardial sac [3].…”

“…Incomplete closure of pleuroperitoneal membranes in utero may leave an aperture by which communication between the pericardial sac and the pleura or peritoneum would persist [4]. This may first reveal itself during laparoscopic procedures [3].…”

Occult pneumopericardium after isolated blunt chest trauma

“…In patients with stable functions, diagnostics (oesophagoscopy/bronchoscopy) could be postponed. High-flow nasal oxygenation and ‘recruitment manoeuvre’ is not recommended 4. Intubation, under analgosedation and muscle relaxation, and volume-assisted mechanical ventilation with limited inspired volume are acceptable, if necessary.…”