Pneumopericardium as a Complication of Pericardiocentesis
- Affiliations
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- 1Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. medsws@catholic.ac.kr
- KMID: 2297937
- DOI: http://doi.org/10.4070/kcj.2011.41.5.280
Abstract
- Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.
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Figure
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Fig. 1 Chest X-ray on admission showed cardiomegaly with a clear lung.
Fig. 2 Two-dimensional echocardiography showed extensive pericardial effusion. LV: left ventricle, LA: left atrium, RV: right ventricle, RA: right atrium, PE: pericardial effusion.
Fig. 3 On day 5, Lucent outline (→) representing the pericardial sac around the heart with clear lung is shown as an image above. Meanwhile, air (*) surrounding the cardiac boarder and air-fluid level (↑) in the pericardial space is also noted. The pericardial drainage catheter (←) has been placed into a loculated effusion using an subxiphoid approach.
Fig. 4 Follow up two-dimensional echocardiography showed multiple bright echogenic spots (white arrow) swirling in the pericardial cavity.
Fig. 5 On day 10, a chest X-ray showed the regression of pericardial air after conservative treatment.
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