Utilidad de la tomografía computarizada multicorte para la estimación de la composición del derrame pericárdico / Usefulness of computed tomography densities to estimate the composition of pericardial effusion

Resumen El derrame pericárdico (DP) es una entidad frecuente en la práctica diaria, que puede ocurrir por un amplio rango de patologías. Los métodos por imágenes constituyen una herramienta diagnóstica clave en la evaluación del pericardio. El ecocardiograma transtorácico (ETT) se considera de primera línea por su costo-efectividad. La tomografía computarizada multicorte (TCMC), por su parte, representa un valioso complemento ante limitaciones del ETT y en la evaluación de urgencia del paciente con sospecha de DP. El objetivo del trabajo es mostrar la utilidad y rol de la TCMC, mediante la medición de densidades, para estimar la etiología del DP, ilustrado con casos de nuestra institución.

Abstract Pericardial effusion (PE) is a common entity in daily practice, which can occur due to a wide range of conditions. Imaging methods are a key diagnostic tool in the evaluation of the pericardium. Transthoracic echocardiogram (TTE) is the first line imaging method because of its cost-effectiveness. Multi-slice Computed Tomography (MSCT), on the other hand, represents a valuable complement to the limitations of TTE and in emergency evaluation of the patient with suspected PE. The objective of this review is to show the usefulness and role of the MSCT —through the measurement of densities— to estimate the etiology of PE, illustrated with cases of our Institution.

Pneumopericardium: A Rare Complication of Pericardiocentesis

Pneumopericardium is defined by the presence of air in the pericardial cavity. It is a rare entity occurring most commonly after trauma. Pneumopericardium resulting after pericardiocentesis is even rarer. We report a case of 46-year-old man, with end-stage renal disease on chronic hemodialysis and who developed a large circumferential pericardial effusion of 40 mm in diastole with swinging heart and diastolic right atrium collapse requiring pericardiocentesis. Few days after, the patient complained of pleuritic chest pain and echocardiogram revealed several tiny sparkling echogenic spots swirling in the pericardial sac. Computed tomography scans revealed a marked anterior pneumopericardium that was conservatively managed.

Tension Pneumopericardium after Pericardiocentesis

Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.

Two Cases of Cervical Emphysema after Tonsillectomy / 대한이비인후과학회지

Although tonsillectomy is a common surgical procedure in the otolaryngological department, subcutaneous emphysema after tonsillectomy is a rare complication. While most of the cases are benign and self-limiting, severe sequelae, such as tracheal compression, pneumopericardium, are possible. We present two patients with cervical emphysema after tonsillectomy, and focus on explaining the possible pathologic mechanisms, diagnosis, appropriate management, and nature course of cervical emphysema after tonsillectomy.

Negative Pressure Pulmonary Edema Together with Pneumopericardium after General Anesthesia / 대한내과학회지

Negative pressure pulmonary edema is an uncommon complication related to general anesthesia. Its main pathophysiology is excessive negative intrathoracic pressure that is caused by an acute upper airway obstruction. Pneumopericardium, the presence of air within the pericardial sac, is another rare condition. The common pathophysiology of pneumopericardium, except for that caused by blunt or penetrating trauma, is barotrauma-induced alveolar rupture caused by positive intrathoracic pressure. Here, we report the case of a 61-year old female patient with negative pulmonary edema and pneumopericardium after general anesthesia. She recovered after conservative management.

Pneumopericardium Caused by Gastropericardial Fistula after Use of NSAIDs in a Patient with Acute Pericarditis and Gastric Cancer / 대한내과학회지

Here, we report a case of gastropericardial fistula associated with the treatment of acute pericarditis using non-steroidal anti-inflammatory drugs (NSAIDs) in the presence of gastric cancer. The patient presented with acute pericarditis with pericardial effusion that had progressed into definite gastropericardial fistula with pneumopericardium after the administration of NSAIDs. The patient improved after conservative management. Based on the current case, we advise caution when using NSAIDs to treat acute pericarditis in the presence of gastric cancer or possible gastropericardial fistula.

Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia / 감염과화학요법

Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.

Boerhaave's syndrome: a differential diagnosis of acute chest pain following a vomiting illness / Síndrome de Boerhaave: un diagnóstico diferencial de dolor torácico, agudo tras enfermedad acompañada de vómitos

Spontaneous oesophageal rupture (Boerhaave's syndrome) is extremely rare in children. Presentation is usually in middle aged men as a result of vomiting following heavy food or alcohol consumption. We describe an unusual case of a 12-year old boy without significant past medical history presenting with acute chest pain following gastroenteritis.

La ruptura esofágica espontánea (síndrome de Boerhaave) es extremadamente rara en niños. Por lo general se presenta en hombres de mediana edad como resultado vómitos tras la ingestión de alcohol o alimentos pesados. Describimos un caso inusual de un niño de 12 años de edad sin antecedentes clínicos significativos, que acudió con dolor torácico agudo tras una gastroenteritis.

Boerhaave Syndrome Presenting as Abrupt Onset of Massive Hydropneumothorax

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.

Two Cases of Tension Pneumopericardium in Mechanically Ventilated Preterm Infants

Pneumopericardium is a rare form of neonatal air leakage. Tension pneumopericardium is much more infrequent, but can cause a cardiovascular deterioration with high mortality up to 80% and neurodevelopmental morbidity in half of the cases. We report two cases of preterm infants who successfully recovered from tension pneumopericardium that developed during mechanical ventilator assistance. The patients displayed a sudden increase in oxygen demand and subsequent cardiovascular deterioration. Immediate needle aspiration of the pneumopericardium performed after checking X-ray images rescued each of patient. Since the clinical symptoms are non-specific, clinicians' suspicion is most important when patients show sudden refractory cardiovascular collapse, especially in ventilator-assisted neonates. This life threatening complication demands instant diagnosis and intervention.

Pneumopericardium as a Complication of Pericardiocentesis

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.

Barotrauma developed during intra-hospital transfer: A case report / 대한마취과학회지

A 74-year-old male patient receiving ventilatory support due to aspiration pneumonia developed bilateral pneumothorax, pneumopericardium, pneumomediastinum, pneumo-retroperitoneum, and subcutaneous emphysema, after manual ventilation while being transferred from the intensive care unit (ICU) to the operating room (OR). These complications were assumed to be secondary to inappropriate manual ventilation of the intubated patient. In addition, it is likely that the possible migration of an already marginally acceptable endotracheal tube (ETT) position during transport was the cause of these complications. Finally, aggravation of a latent pneumothorax might have contributed to these complications.

Pneumorrhachis, pneumomediastinum, pneumopericardium and subcutaneous emphysema as complications of bronchial asthma

Pneumorrhachis [PR], or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself as well as by its underlying pathology. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR, and its treatment is often individualized. Frequently, multidisciplinary approach and regimes are required for its management. PR associated with bronchial asthma is extremely rare, and only very few cases are reported in the literature. Here, we report a case of a 17-year-old Saudi male patient who is a known case of bronchial asthma; he presented with extensive subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumorrhachis as complications of an acute exacerbation of his primary ailment

A Case Report of Tension Pneumopericardium Following Blunt Chest Trauma / 대한흉부외과학회지

A 49-year-old man visited our hospital via the emergency room. He had suffered chest trauma by falling down. His chest X-Ray showed pneumomediastinum with pneumopericardium. We checked the Chest CT, and it showed pneumopericardium without any injury to the other organs, the compressed heart and a minimal pneumothorax on the left hemithorax. Closed thoracostomy was then done under local anesthesia. We then performed open pericardiostomy under general anesthesia. We got a good result and so we report on this case.

Cardiac Tamponade by Iatrogenic Pneumopericardium

Pneumopericardium is defined as the condition of presence of air in the pericardial space. It is associated with various etiologies such as chest trauma, infection or invasive procedures. We herein describe a case of cardiac tamponade associated with pneumopericardium. We diagnosed iatrogenic pneumopericardium by plain chest radiography and two-dimensional echocardiography. The patient was successfully treated by re-pericardiocentesis.

Pneumoretroperitoneum, Pneumomediastinum, Peumopericardium, and Subcutaneous Emphysema after Colonoscopic Examination

Colonoscopy is regarded as a relatively safe procedure and is widely performed. However, complications such as bleeding, perforation, and coagulation syndromes can occur during colonoscopy. Although bowel perforation is as rare as 0.4-1.9% of cases, it is the most serious and awful adverse event which can lead to a death. Colon perforation may occur as either intraperitoneal or extraperitoneal, or in combination. Right subdiaphragmatic free air suggests intraperitoneal perforation while pneumoretroperitoneum, pneumomediastinum, pneumopericardium, and subcutaneous emphysema suggest extraperitoneal perforation. Combined intraperitoneal and extraperitoneal perforation is very rare. Herein, we present a case of combined intraperitoneal and extraperitoneal colon perforation which manifested as pneumoretroperitoneum, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. The lesion was closed with endoscopic clipping.

Pneumotorax e pneumopericárdio hipertensivo em cirurgia cardiotorácica / Pneumothorax and tension pneumopericardium following cardiothoracic surgery

São apresentados dois casos de pacientes com pneumotorax e pneumopericárdio hipertensivo, em pós-operatório de cirurgia cardiotorácica. Ambos tiveram abertura do pericárdio como um dos tempos cirúrgicos da operação inicial e apresentaram sintomas de tamponamento pericárdico como complicação. O tratamento foi uma drenagem pleural nos dois casos, que evoluíram para resolução do processo.

Pneumomediastinum and pneumopericardium--a clinical condition of multispeciality interest.

Pneumomediastinum with its usual associations like pneumopericardium has been described in detail including review of literature, aetiopathogenesis, symptoms and signs, complications, necessary investigations and management protocol by the authors in this article of multispeciality interest.