An extremely rare combination: pneumopericardium, pneumoperitoneum, and subcutanous emphysema-a case report

Fatal pneumopericardium in a road traffic accident: An uncommon contributor to death in the presence of traumatic brain injury

A pneumopericardium is a condition characterized by the presence of air or gas within the pericardial sac. Sixty percent of pneumopericardium in adults is caused by traumatic events, specifically penetrating chest trauma. Clinical monitoring is sufficient for patients with no hemodynamic instability while waiting for air absorption. In contrast, if pericardial tamponade develops, pericardiocentesis or immediate surgery to seal the channel between air and pericardium is required. However, whenever there are multiple injuries are present, the clinician's attention can divert to a more severe form of injury and may miss other injuries that can be potentially fatal. We present a rare case of isolated pneumopericardium without pneumothorax in a 48-year-old male who was involved in a road traffic accident. The condition developed gradually and was only identified during the postmortem. We provide a detailed account of the clinical presentation, hospital course, and macroscopic and microscopic autopsy features. This case report emphasizes the necessity of assessing all possible complications in polytrauma cases that have the potential to be fatal despite the fact that they were not identified during the initial evaluation.

A case of pneumopericardium due to metallic stent placement in the esophagus

Pneumopericardium, defined as the presence of air inside the pericardial cavity, is generally considered to be an emergency because it can cause cardiac tamponade. Pneumopericardium associated with self-expanding metallic stent (SEMS) placement is extremely rare. We present a fatal case of pneumopericardium caused by SEMS placement. An 84 year-old man had tumor-induced stenosis of the jejunal limb after total gastrectomy. SEMSs were inserted twice to improve the symptoms without complications. Two days after the implantation of a central venous access port for anorexia, the patient suddenly complained of chest pain and dyspnea, and decreased blood pressure was observed. Chest CT revealed the presence of air in the pericardial cavity. As urgent echography showed cardiac tamponade, pericardiocentesis was performed immediately. The hemodynamic condition temporarily improved after drainage. Although we planned the placement of an additional SEMS to close the fistula, he died 3 days after the onset of symptoms. Pneumopericardium with cardiac tamponade is a potentially fatal situation. An early diagnosis and treatment are important for the management of esophago-pericardial fistula. Prompt drainage is the best management and SEMS placement can achieve effective short-term results.

Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report

INTRODUCTION

Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain.

CLINICAL CASE REPORT

A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium.

CLINICAL CONCLUSION

A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.

Asymptomatic Spontaneous Pneumopericardium, Pneumomediastinum, and Subcutaneous Emphysema: A Case Report of an Incidental Rare Presentation

Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. They are normally self-limited unless tension pneumothorax, tension PM, cardiac herniation, air tamponade, and esophageal rupture accompany these disorders. PM and PP can be divided into "spontaneous" or "secondary" based on the preceding etiologies. Spontaneous PM is often extremely rare and benign in course. On the other hand, secondary PM and PP are more common and result from intrathoracic infections, trauma-related esophageal rupture, or tears along the tracheobronchial tree. Our patient presented four days after a fall from a chair and was found to have suffered a stroke, with complete left side paralysis. CT imaging on arrival was significant for PM, PP, and SE, the cause of which remains unclear. The patient was diagnosed with COVID-pneumonia approximately six months prior to presentation. As the COVID-19 pandemic has evolved, several scientific papers have been published reporting infected patients who had developed spontaneous PT, PM, or even PP, in the absence of invasive mechanical ventilation. Is it possible that the spontaneous findings in our patient were COVID-related? Or could the spontaneous PP, PM, and SE be a sequel to the trauma of her fall from a chair? The answer still remains unclear.

A Rare Iatrogenic Trio: Pneumopericardium, Pneumoperitoneum, and Pericarditis

We present a rare case of iatrogenic pneumopericardium, pneumoperitoneum, and Escherichia coli pericarditis after emergency pericardiocentesis for pericardial tamponade. The patient had profound bowel distention at the time of the procedure that led to iatrogenic pericardioperitoneal fistula formation along with transverse colon perforation, which manifested later after pericardial drain removal. This condition required repeat pericardiocentesis, laparoscopic colon repair, a long course of antibiotics, and an eventual pericardial window. (Level of Difficulty: Intermediate.).

Pneumopericardium: A Rare Complication of Pericardiocentesis

Pneumopericardium is defined by the presence of air in the pericardial cavity. It is a rare entity occurring most commonly after trauma. Pneumopericardium resulting after pericardiocentesis is even rarer. We report a case of 46-year-old man, with end-stage renal disease on chronic hemodialysis and who developed a large circumferential pericardial effusion of 40 mm in diastole with swinging heart and diastolic right atrium collapse requiring pericardiocentesis. Few days after, the patient complained of pleuritic chest pain and echocardiogram revealed several tiny sparkling echogenic spots swirling in the pericardial sac. Computed tomography scans revealed a marked anterior pneumopericardium that was conservatively managed.