J Cardiovasc Ultrasound.  2016 Mar;24(1):55-59. 10.4250/jcu.2016.24.1.55.

Pneumopericardium: A Rare Complication of Pericardiocentesis

• Iskander S
• Amar H
• Audrey B
• Fabien D

• KMID: 2160996
• DOI: http://doi.org/10.4250/jcu.2016.24.1.55

Abstract

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.

Keyword

Pericardial effusion; Pericardiocentesis; Pneumopericardium; Chest tomography

MeSH Terms

Chest Pain
Diastole
Heart
Heart Atria
Humans
Kidney Failure, Chronic
Middle Aged
Pericardial Effusion
Pericardiocentesis*
Pneumopericardium*
Renal Dialysis

Figure

• 

  Fig. 1 Two dimensional echocardiography. Parasternal long-axis view showing a large circumferential pericardial effusion of 40 mm in diastole. LV: left ventricle, PE: pericardial effusion.

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  Fig. 2 Pulsed wave Doppler mode showing no significant respiratory variations of the mitral inflow (A) and aortic flow (B).

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  Fig. 3 Two dimensional echocardiography. Parasternal short-axis view showing several tiny sparkling echogenic spots swirling in the pericardial sac evoking micro air bubbles (open arrows). PE: pericardial effusion, RV: right ventricle, Ao: aorta, PA: pulmonary artery.

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  Fig. 4 Two dimensional echocardiography. Parasternal short-axis view (mid-ventricular) showing a partial disappearance of the shape of cardiac chambers in late systole with a band of echoes within (A). Reappearance of cardiac cavities in late diastole (B). RV: right ventricle, LV: left ventricle.

• 

  Fig. 5 Chest computed tomography scan revealed a marked pneumopericardium with an anterior extent (white arrows) associated to small amount of pericardial fluid signing a hemopericard (dark red arrows).

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