Imaging in cardiology M.J.M. Cramer and W. Jaarsma, editors Figure 1.

f.1

Pneumopericardium A 53-year-old woman was admitted to our hospital with acute chest and back pain. She has tuberous sclerosis and epilepsy, and had undergone surgical correction of a diaphragmatic hernia a year previously because of severe gastro-oesophageal reflux. Physical examination was normal with the exception of a temperature of39 'C. A twelve-lead electrocardiogram showed discrete signs of pericarditis and borderline low voltages in the precordial leads, but no other abnormalities. A CT scan ofthe thorax identified a large quantity ofair in the pericardium. Gastroscopy showed a Barrett oesophagus with multiple ulcers, one of which had perforated into the pericardium. The chest X-ray demonstrates the unusual finding of pneumopericardium. The patient was treated surgically. Her postoperative course was protracted and stormy, but

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she was finally discharged in good health six weeks after admission. TA. Simmers. S. Ruiz Bustillo. Department ofCardiology, University Medical Centre, Utrecht.

In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands.

Netherlands Heart Joumal, Volume 9, Number 3, June 2001

Pneumopericardium.

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