Intrapericardial spontaneous contrast echoes in pneumopyopericardium due to a gas-forming organism

Spontaneous Echo Contrast in Purulent Pericardial Effusion due to Non-Gas-Forming Organisms

We present the case of a 55-year-old man who developed massive pericardial effusion with tamponade within a 5-day period. During transthoracic two-dimensional echocardiographic examination, spontaneous echo contrast was visualized in pericardial effusion. A diagnosis of polymicrobial pyopericarditis was made when urgent pericardiocentesis revealed a significantly foul odor and purulent fluid that grew a culture of aerobes. After surgical drainage and appropriate antimicrobial therapy, this patient's pyopericarditis resolved. It was suggested that spontaneous echo contrast in pericardial effusion could be induced by non-gas-forming pyogenic cells.

Afebrile spontaneous pneumopyopericardium

A 77-year-old woman had spontaneous pneumopyopericardium caused by Klebsiella pneumoniae. Chest X-ray revealed a horizontal air-fluid level in the cardiac shadow. Echocardiogram showed characteristic spontaneous contrast echoes in the pericardial effusion. She received pericardiectomy and remained in good condition postoperatively.

Tension pneumopericardium following blunt injury

Pneumopericardium caused cardiac tamponade in a patient who was struck in the chest by a motor vehicle. Subxiphoid pericardial window and pericardial drainage successfully treated this condition. Diagnosis of this rare form of tamponade depends on clinical examination supported by chest radiographic findings.

Echocardiographic diagnosis of pneumopericardium and hydropneumopericardium

Pneumopericardium and hydropneumopericardium are rare conditions in which hemodynamic compromise is common. Loss of the M-mode and two-dimensional image coincident with the systolic phase of each cardiac cycle and swirling echogenic bubbles within the pericardial space produce a distinctive M-mode and two-dimensional echocardiographic appearance. This provides an additional method for prompt diagnosis.