There's air in there: An image of extensive pneumopericardium and pneumomediastinum
✍ Scribed by Aparajita Singh; Brian Harte
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 160 KB
- Volume
- 4
- Category
- Article
- ISSN
- 1553-5592
- DOI
- 10.1002/jhm.475
No coin nor oath required. For personal study only.
✦ Synopsis
A 73-year-old male presented with acute congestive heart failure and non-ST elevation myocardial infarction. His initial chest x-ray and computed tomography (CT) demonstrated pulmonary vascular congestion and alveolar infiltrates, and he promptly underwent cardiac catheterization with placement of a coronary stent. Subsequently, his respiratory status deteriorated, and repeat films and chest CT demonstrated extensive pneumomediastinum and pneumopericardium (Figures 123). The patient was intubated, and bronchoscopy and upper gastrointestinal (GI) endoscopy were performed, but demonstrated no evidence of perforation that could cause such an air leak. There was no evidence of tamponade, clinically or on echocardiogram. His condition worsened abruptly, and he expired following a cardiac arrest. Postmortem, the team considered that the extensive air leak could have been caused by catheterization, stent placement, central line placement, or mediastinitis or pericarditis causing microscopic fistulae. The patient's tracheal aspirate and biopsy grew Candida albicans but no ''mill wheel murmur'') in hydropneumopericardium. 5 Chest CT can distinguish pneumopericardium from pneumomediastinum: with the former, the air changes position when the patient adopts a supine position. 6 Cardiac tamponade can occur in up to 37% of cases, and pericardiocentesis or pericardial tube drainage in these cases can be lifesaving. 7