Successful treatment with positive airway pressure ventilation for tension pneumopericardium after pericardiocentesis in a neonate: a case report

Abstract

Background Pneumopericardium in neonates is often associated with respiratory diseases, of which positive pressure ventilation (PPV) is an exacerbating factor. Here, we present a neonate case of pneumopericardium after cardiac surgery which was resolved after applying PPV. Case presentation A 28-day-old neonate with left recurrent nerve palsy after aortic reconstruction for interrupted aortic arch developed pericardial effusion. Pericardiocentesis was performed under general anesthesia, and a drainage tube was left in the pericardium. After extubation, stridor gradually exacerbated, following hemodynamic deterioration. A chest X-ray demonstrated pneumopericardium. Upper airway stenosis due to recurrent nerve palsy developed excessive negative pleural pressure, and air was drawn into pericardium via the insertion site of the drainage tube. After tracheal intubation and applying PPV, the pneumopericardium improved. Conclusion PPV does not always exacerbate pneumopericardium. In a patient with pericardial-atmosphere communication, increased inspiration effort can cause pneumopericardium, and PPV is a therapeutic option to alleviate the pneumopericardium.

Pneumopericardium in a Newborn with Respiratory Distress and COVID-19

“…Spontaneous PPC in neonates is associated with pulmonary diseases such as hypoplasia and RD syndrome. Traumatic PPC occurs by pleural-pericardial communication associated with chest trauma and iatrogenic chest injury [1]. The pathogenesis of PPC is thought to be due to high bronchoalveolar pressure causing rupture of alveoli and air leakage into the perivascular interstitium of the lung, hilum, and mediastinum, then to the pericardial space on pulmonary vein reflection which is postulated to have an anatomical weakness [3].…”

“…Pneumopericardium (PPC) is a condition where air collects in the pericardium. Its one of the rarest pulmonary air leak syndromes, but the incidence is the highest in the neonatal period [1], [2]. Risk factors for PPC include premature infants with respiratory distress (RD) syndrome, receiving active resuscitation, meconium aspiration syndrome (MAS), and aggressive mechanical ventilation (MV).…”