Pneumopericardium: Difference between revisions
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==Background== | ==Background== | ||
[[File:Body Cavities Frontal view labeled 2.jpg|thumb|The pericardial cavity in this image is labeled d and is part of the inferior mediastium. Here we can see its relation to the superior mediastinum a, the pleural cavities c, and the diaphragm e.]] | |||
[[File:2004 Heart Wall.jpg|thumb|Anatomy of the pericardium.]] | |||
*Air in the pericardium | *Air in the pericardium | ||
*Generally secondary to connection between pericardium and pleural cavity, bronchi, or GI tract | *Generally secondary to connection between pericardium and pleural cavity, bronchi, or GI tract | ||
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*[[Blast injury]] | *[[Blast injury]] | ||
*Blunt or penetrating [[thoracic trauma]] | *Blunt or penetrating [[thoracic trauma]] | ||
*Neonatal respiratory distress syndrome | *Neonatal [[respiratory distress syndrome]] | ||
==Clinical Features== | ==Clinical Features== | ||
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**[[Chest pain]] | **[[Chest pain]] | ||
**[[Pulsus paradoxus]] | **[[Pulsus paradoxus]] | ||
**Bradycardia | **[[Bradycardia]] | ||
**Tachycardia | **[[Tachycardia]] | ||
**May have subcutaneous emphysema | |||
**May have succussion splash if there is also a pericardial effusion | |||
**May have Hamman crunch | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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[[File:PMC4121728 pjms-30-924-g001.png|thumb|CT showing tension pneumopericardium, subcutaneous emphysema, bilateral pneumothorax, and a compressed heart.]] | [[File:PMC4121728 pjms-30-924-g001.png|thumb|CT showing tension pneumopericardium, subcutaneous emphysema, bilateral pneumothorax, and a compressed heart.]] | ||
*Assess for underlying cause | *Assess for underlying cause | ||
*[[CXR]]<ref>Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.</ref> | *[[CXR]]<ref>Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.</ref> | ||
**Heart partially or completely surrounded by gas | **Heart partially or completely surrounded by gas | ||
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*Treat underlying cause | *Treat underlying cause | ||
*Conservative management usually sufficient (usually self-resolves) | *Conservative management usually sufficient (usually self-resolves) | ||
*If tamponade physiology, may require pericardiocentesis | *If tamponade physiology, may require [[pericardiocentesis]] | ||
**If communicating pneumothorax, chest tube placement may resolve both<ref>Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).</ref> | **If communicating pneumothorax, [[chest tube]] placement may resolve both<ref>Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).</ref> | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[Thoracic trauma]] | *[[Thoracic trauma]] | ||
==References== | ==References== | ||
Latest revision as of 22:07, 20 April 2022
Background
- Air in the pericardium
- Generally secondary to connection between pericardium and pleural cavity, bronchi, or GI tract
- Most often found following trauma, severe asthma exacerbation, strangulation, or forceful drug insufflation
Causes of pneumopericardium
- GI malignancy
- PUD
- Esophageal diverticula
- Barotrauma
- Mechanical ventilation
- Vigorous bag-mask ventilation
- SCUBA diving/rapid ascent
- Drug insufflation (especially associated with crack cocaine)
- Asthma
- Valsalva
- Infection pericarditis with gas-producing bacteria
- Thoracic surgery
- Pericardial fluid drainage
- Blast injury
- Blunt or penetrating thoracic trauma
- Neonatal respiratory distress syndrome
Clinical Features
- May present with tamponade physiology depending on size
- Other features include:
- Dyspnea
- Cyanosis
- Chest pain
- Pulsus paradoxus
- Bradycardia
- Tachycardia
- May have subcutaneous emphysema
- May have succussion splash if there is also a pericardial effusion
- May have Hamman crunch
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Assess for underlying cause
- CXR[1]
- Heart partially or completely surrounded by gas
- Pericardium sharply outlined by gas density on either side
- Continuous diaphragm sign may be present (diaphragm seen continuously across the midline
- PoCUS[2]
- Bright spots moving along pericardial layer during diastole
- Comet-tail artefacts extending across heart and disappearing during systole
Management
- Treat underlying cause
- Conservative management usually sufficient (usually self-resolves)
- If tamponade physiology, may require pericardiocentesis
- If communicating pneumothorax, chest tube placement may resolve both[3]
Disposition
- If underlying cause is stable and patient is asymptomatic, may discharge home
- Most patients will require admission for treatment of underlying cause
See Also
References
- ↑ Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.
- ↑ Bobbia et al. (2013). Pneumopericardium diagnosis by point-of-care ultrasonography. Journal of Clinical Ultrasound, 4(14), May 2013.
- ↑ Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).