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


==Clinical Features==
==Differential Diagnosis==
===Causes of pneumopericardium===
===Causes of pneumopericardium===
*GI malignancy
*GI malignancy
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*Esophageal diverticula
*Esophageal diverticula
*[[Barotrauma]]
*[[Barotrauma]]
**Mechanical ventilation
**Vigorous bag-mask ventilation
**SCUBA diving/rapid ascent
**Drug insufflation (especially associated with crack [[cocaine]])
*[[Asthma]]
*[[Asthma]]
*Valsalva
*Valsalva
*Drug inhalation
*Infection [[pericarditis]] with gas-producing bacteria
*Infectious pericarditis with gas-producing bacteria
*Thoracic surgery
*Thoracic surgery
*Pericardial fluid drainage
*Pericardial fluid drainage
*[[Blast injury]]
*[[Blast injury]]
*Blunt trauma
*Blunt or penetrating [[thoracic trauma]]
*Penetrating 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


==Diagnosis==
==Differential Diagnosis==
{{Thoracic trauma DDX}}


==Evaluation==
[[File:PMC2700481 ATM-04-75-g032.png|thumb|Lucent line around the heart extending up to the main pulmonary arteries (solid white arrows). Air may accumulate inferior to the cardiac shadow, which crosses the midline above the diaphragm (i.e. continuous diaphragm sign)]]
[[File:PMC4782482 APC-9-94-g002.png|thumb|Pneumopericardium on chest x-ray after battery button ingestion.]]
[[File:PMC4121728 pjms-30-924-g001.png|thumb|CT showing tension pneumopericardium, subcutaneous emphysema, bilateral pneumothorax, and a compressed heart.]]
*Assess for underlying cause
*[[CXR]]<ref>Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.</ref>
**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<ref>Bobbia et al. (2013). Pneumopericardium diagnosis by point-of-care ultrasonography. Journal of Clinical Ultrasound, 4(14), May 2013.</ref>
**Bright spots moving along pericardial layer during diastole
**Comet-tail artefacts extending across heart and disappearing during systole


==Management==
==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<ref>Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).</ref>


==Disposition==
==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==
==See Also==
 
*[[Thoracic trauma]]


==References==
==References==
<References/>
<References/>


[[Category:Cards]]
[[Category:Cardiology]]

Latest revision as of 22:07, 20 April 2022

Background

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.
Anatomy of the pericardium.
  • 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

Clinical Features

Differential Diagnosis

Thoracic Trauma

Evaluation

Lucent line around the heart extending up to the main pulmonary arteries (solid white arrows). Air may accumulate inferior to the cardiac shadow, which crosses the midline above the diaphragm (i.e. continuous diaphragm sign)
Pneumopericardium on chest x-ray after battery button ingestion.
CT showing tension pneumopericardium, subcutaneous emphysema, bilateral pneumothorax, and a compressed heart.
  • 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

  1. ↑ Bell, D. et al. Pneumopericardium. Radiopaedia.org. Retrieved March 8 2019.
  2. ↑ Bobbia et al. (2013). Pneumopericardium diagnosis by point-of-care ultrasonography. Journal of Clinical Ultrasound, 4(14), May 2013.
  3. ↑ Braiteh, F., and Malik, I. (2008). Pneumopericardium. Canadian Journal of Emergency Medicine, 179(10).
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