Spontaneous pneumomediastinum mimicking acute pericarditis

Abstract

ST elevations on electrocardiogram (ECG) have a broad differential diagnosis that can vary from benign to more ominous pathologies. These include early repolarization, coronary vasospasm, acute pericarditis, ST‐elevation myocardial infarction, ventricular aneurysms, and dissecting aneurysm of the aorta reaching the pericardium. ST‐segment changes may also provide a clue to the presence of spontaneous pneumomediastinum (SPM). These ECG changes are seldom reported in literature. We describe two SPM cases with concomitant pneumopericardium that closely mimicked acute pericarditis with a deceptive clinical spectrum.

A clinical review of spontaneous pneumomediastinum

“…Findings on thoracic ultrasound include poor visualization of the heart, diffuse A lines, and normal visualization of the heart from the subxiphoid view ( 12 , 30 ). Laboratory and electrocardiogram (ECG) findings are non-diagnostic and non-specific; laboratory findings may demonstrate leukocytosis or increased C-reactive protein (CRP) while ECG findings may mimic acute pericarditis ( 31 , 32 ). Echocardiography may be used in case of suspicion for pneumopericardium.…”

超音波検査が診断に有用であった心嚢気腫による心タンポナーデの1例(Ultrasonographic diagnosis of cardiac tamponade due to pneumopericardium: a case report)

“…本症例では，心嚢気腫の診断後にST上昇の心電図変化があった。心臓超音波画像では，壁運動異常の評価ができず，心臓カテーテル検査で冠動脈の評価を行ったが，外傷による損傷や狭窄病変はなかった。これまで心嚢気腫の心電図変化の報告は散見され，鈍的外傷において心嚢気腫によるST低下・上昇，T波の陰性化，低電位が起こるとされている 7)。さらに，心嚢気腫によるST上昇は，急性心膜炎と同様に空気が心膜腔に漏れることにより炎症が起こり，生じたという報告もある 8)。開心術後に生じる心膜切開後症候群では，時にST上昇が認められると報告されている 9)。今回の心電図変化は，最終的に外傷に伴う心膜の炎症によると考えた。…”

Hamman’s Sign: Rediscovering Cardiac Auscultation Through a Pneumomediastinum

“…There are other reports where Hamman's sign on auscultation was misinterpreted as a pericardial rub leading to the false assumption of acute pericarditis. [2][3][4] Pericardial rubs result from the inflammation of the pericardium producing a 'scratchy' sound best heard within the left third intercostal space, leaning forward, after forced expiration. On the other hand, Hammam's sign results from the dissected air during systole, producing a 'crunching' and 'crackling' noise that is synchronous with the heartbeat.…”