Pneumopericardium: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Assess for underlying cause | |||
*Assess vital signs for tamponade physiology | |||
*[[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== | ||
Revision as of 19:19, 8 March 2019
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
Clinical Features
- May present with tamponade physiology depending on size
- Other features include:
- Dyspnea
- Cyanosis
- Chest pain
- Pulsus paradoxus
- Bradycardia
- Tachycardia
Differential Diagnosis
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
Evaluation
- Assess for underlying cause
- Assess vital signs for tamponade physiology
- 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