Spontaneous Pneumopericardium in a Case of Cavitating Pulmonary Metastasis With Pulmonary-Pericardial Fistula

Abstract

Pneumopericardium is collection of air in the pericardial cavity. Though this condition is uncommon, there are many causes for pneumopericardium, of which, trauma is the commonest. This case report is a presentation of an uncommon condition of cavitating secondary deposit in the lung from carcinoma tongue, with a fistulous communication with the pericardial cavity causing hydropneumopericardium. Various causes of pneumopericardium, its clinical implications, complications, diagnosis and management are discussed briefly. COMPLICATION: Tension pneumopericardium leading to cardiac tamponade occasionally complicates pneumopericardium.This complication is because of a ball valve mechanism which prevents air from leaving the pericardial space. CONCLUSIONS:In the present case, the patient had a history of carcinoma of tongue and had undergone radiation therapy 6 months back.The cavity in the left upper lobe is considered as a secondary deposit as there are multiple chest wall soft tissue secondary deposits, pelvic bone secondaries and the rest of the lung shows no signs of acute or chronic infection or inflammation. This needs to be proved by biopsy, however, rapid growth of the cavity in comparison with pervious CT scan indicates malignancy.This lesion showed fistulous communication with the pericardium (pulmonary pericardial fistula) causing hydropneumopericardium.