J Cardiovasc Ultrasound.  2008 Mar;16(1):26-28. 10.4250/jcu.2008.16.1.26.

Cardiac Tamponade by Iatrogenic Pneumopericardium

• Lee SH
• Kim WH
• Lee SR
• Rhee KS
• Chae JK
• Ko JK

• KMID: 1486607
• DOI: http://doi.org/10.4250/jcu.2008.16.1.26

Abstract

Pneumopericardium is defined as the condition of presence of air in the pericardial space. It is associated with various etiologies such as chest trauma, infection or invasive procedures. We herein describe a case of cardiac tamponade associated with pneumopericardium. We diagnosed iatrogenic pneumopericardium by plain chest radiography and two-dimensional echocardiography. The patient was successfully treated by re-pericardiocentesis.

Keyword

Pneumopericardium; Pericardiocentesis; Cardiac tamponade

MeSH Terms

Cardiac Tamponade
Echocardiography
Humans
Pericardiocentesis
Pneumopericardium
Thorax

Figure

• 

  Fig. 1 A: Chest X-ray showed cardiomegaly with bilteral pleural effusions at admission. B: Chest PA on third hospital day demonstrated cardiomegaly with the line separating pericardium from the heart (black arrow heads) and "continuous diaphragm sign" (white arrow heads) implying presence of air in the pericardial cavity, pneumopericardium. C-D: Both decubitus views revealed thin parietal pericardium (white arrows) and air-fluid level (black arrows) in the pericardial cavity, which suggests hydropneumopericardium.

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  Fig. 2 Two-dimensional echocardiography [A: apical four-chamber view, B: parasternal short axis view, papillary muscle level] showed pericardial effusion (PE) with the "swirling bubbles sign" that indicated multiple unusual tiny echo-bright spots (white arrows) in pericardial cavity, suggesting formation of air microbubbles through continuous shaking of the air-fluid surface with heart beats. LV: left ventricle, LA: left atrium, RA: right atrium.

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  Fig. 3 Cine-fluoroscopy demonstrated large multiple lumps of air (black arrows) moving in the pericardial cavity with the heart beats.

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