Pneumopericardium
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 (Beck's triad)
- Physical examination:
- May have subcutaneous emphysema
- May have succussion splash if there is also a pericardial effusion
- May have Hamman crunch
- 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