The Journal of Emergency Medicine, Vol. 46, No. 5, pp. 687–688, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2013.11.070
Visual Diagnosis in Emergency Medicine
TENSION PNEUMOPERICARDIUM Pak-On Leung, MD and Chih-Cheng Lai, MD Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan Reprint Address: Chih-Cheng Lai, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
CASE REPORT A 51-year-old man presented to our emergency department with acute onset of dyspnea after forceful vomiting. He denied any recent trauma history, but he had a history of buccal cancer and was receiving concurrent chemoradiotherapy. On arrival, his vital signs were the following: pulse rate of 130 beats/min, respiratory rate of 24 breaths/ min, and blood pressure of 82/53 mm Hg. Chest radiography (Figure 1) showed pneumopericardium (arrows). Emergent aspiration using the subxiphoid approach under echo guidance was performed for relief of pneumopericardium, and more than 200 mL air was smoothly aspirated. Thereafter, his hemodynamic status became stable. DISCUSSION Pneumopericardium is defined as the presence of air within the pericardial space, and its severe form – tension pneumopericardium – can cause cardiovascular compromise. Most cases of pneumopericardium are caused by infection, mechanical ventilation, or traumatic or iatrogenic injury; however, pneumopericardium can rarely develop without specific etiology (1). As in the present case, it is classified as ‘‘spontaneous pneumopericardium.’’ Sometimes, simple pneumopericardium may progress to tension pneumopericardium if physicians do not manage this clinical condition promptly. Tension
Figure 1. Chest radiography showed pneumopericardium (arrows).
pneumopericardium is a life-threatening condition and mandates immediate drainage (2).
RECEIVED: 9 April 2013; FINAL SUBMISSION RECEIVED: 18 July 2013; ACCEPTED: 16 November 2013 687
688
In conclusion, physicians should keep in mind this rare and fatal clinical entity – tension pneumopericardium – and simple chest radiography would provide useful information to make the diagnosis. Most important of all, prompt and appropriate drainage can save a life.
P.-O. Leung and C.-C. Lai
REFERENCES 1. Macgoey P, Schamm M, Degiannis E. Tension pneumopericardium: case report. Ulus Travma Acil Cerrahi Derg 2010;16:477–9. 2. Polhill JL, Sing RF. Traumatic tension pneumopericardium. J Trauma 2009;66:1261.
http://dx.doi.org/10.1016/j.jemermed.2013.11.070
Visual Diagnosis in Emergency Medicine
TENSION PNEUMOPERICARDIUM Pak-On Leung, MD and Chih-Cheng Lai, MD Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan Reprint Address: Chih-Cheng Lai, MD, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
CASE REPORT A 51-year-old man presented to our emergency department with acute onset of dyspnea after forceful vomiting. He denied any recent trauma history, but he had a history of buccal cancer and was receiving concurrent chemoradiotherapy. On arrival, his vital signs were the following: pulse rate of 130 beats/min, respiratory rate of 24 breaths/ min, and blood pressure of 82/53 mm Hg. Chest radiography (Figure 1) showed pneumopericardium (arrows). Emergent aspiration using the subxiphoid approach under echo guidance was performed for relief of pneumopericardium, and more than 200 mL air was smoothly aspirated. Thereafter, his hemodynamic status became stable. DISCUSSION Pneumopericardium is defined as the presence of air within the pericardial space, and its severe form – tension pneumopericardium – can cause cardiovascular compromise. Most cases of pneumopericardium are caused by infection, mechanical ventilation, or traumatic or iatrogenic injury; however, pneumopericardium can rarely develop without specific etiology (1). As in the present case, it is classified as ‘‘spontaneous pneumopericardium.’’ Sometimes, simple pneumopericardium may progress to tension pneumopericardium if physicians do not manage this clinical condition promptly. Tension
Figure 1. Chest radiography showed pneumopericardium (arrows).
pneumopericardium is a life-threatening condition and mandates immediate drainage (2).
RECEIVED: 9 April 2013; FINAL SUBMISSION RECEIVED: 18 July 2013; ACCEPTED: 16 November 2013 687
688
In conclusion, physicians should keep in mind this rare and fatal clinical entity – tension pneumopericardium – and simple chest radiography would provide useful information to make the diagnosis. Most important of all, prompt and appropriate drainage can save a life.
P.-O. Leung and C.-C. Lai
REFERENCES 1. Macgoey P, Schamm M, Degiannis E. Tension pneumopericardium: case report. Ulus Travma Acil Cerrahi Derg 2010;16:477–9. 2. Polhill JL, Sing RF. Traumatic tension pneumopericardium. J Trauma 2009;66:1261.
