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HWN Suggests

Tension Pneumopericardium From Blunt Force Trauma: Resuscitating the Red Baron

Typically, pneumopericardium is believed to be benign and can be observed. It can be caused by infection; iatrogenic injury; and blunt, penetrating or baro-trauma. However, previous literature suggests up to 37% of patients with pneumopericardium due to blunt thoracic trauma may develop some degree of tension pneumopericardium. As well, simple pneumopericardium may progress to tension pneumopericardium. As with tension pneumothorax, the development of tamponade physiology secondary to tension pneumopericardium is strongly associated with positive pressure ventilation.

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Articles of Interest

A Rare Evolution to Pneumopericardium in Patient with COVID-19 Pneumonia Treated with High Flow Nasal Cannula

If the pneumopericardium is particularly extensive or recurrent in its presentation, inserting a drainage tube into the pericardial sac may be necessary.

A Rare Iatrogenic Trio: Pneumopericardium, Pneumoperitoneum, and Pericarditis

An initial diagnosis of pneumopericardium can be made on the basis of a chest radiograph or CT scan. Once the diagnosis is established, management depends on the hemodynamic status of the patient. Although the development of pneumopericardium is an unfavorable prognostic marker, stable patients can be managed by treating the underlying condition and with supportive care with close monitoring. However, in the case of hemodynamic compromise, urgent pericardiocentesis is indicated

Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema.

Spontaneous pneumopericardium in acute asthma

Pneumopericardium is usually self-limiting but features of tamponade may necessitate pericardiocentesis.

The Cardiac Halo: Pneumopericardium Revisited

On chest radiographs, a continuous rim of air outlined by a radiopaque line representing the pericardial sac, is characteristic. This is known as the “Halo sign”. This radiolucent line of air is distinctively confined to below the aortic arch. Many etiological factors have been described for pneumopericardium, including trauma, invasive procedures, barotrauma, fistulae and pericardial infections [2]. The asymptomatic stable patient requires only observation, but patients with tension pneumothorax and tamponade require urgent pericardiocentesis.

Resources

BC Emergency Medicine Network

Although unreliable for detecting pneumopericardium, Bruit de Moulin and Hamman’s Crunch are signs that suggest the pathology.

CMAJ

Pneumopericardium is encountered mainly in the context of chest trauma and mechanical ventilation.

EuroRad

Pneumopericardium is a relatively rare condition, less common than isolated pneumomediastinum or pneumothorax.

Radiopedia

A pneumopericardium can usually be distinguished from pneumomediastinum since gas in the pericardial sac should not rise above the anatomic limits of the pericardial reflection on the proximal great vascular pedicle. Also on radiographs obtained with the patient in the decubitus position, gas in the pericardial sac will shift immediately, while gas in the mediastinum will not shift in a short interval between films.

WikEM

Most often found following trauma, severe asthma exacerbation, strangulation, or forceful drug insufflation.