pneumopericardium

Introduction

air in the pericardial cavity

Etiology

• trauma (most common)
• fistula between pericardium &
  • pleural space
  • pulmonary alveoli
  • bronchial tree
  • gastrointestinal tract
• gas produced by microorganisms invading the pericardial sac
  • Clostridium perfringens
  • Klebsiella

Epidemiology

• rare

Clinical manifestations

• 'mill wheel' murmur
• shifting tympany - observed with precordium percussion in recumbent & upright positions

Diagnostic procedures

• electrocardiogram: see pericarditis
• echocardiogram may reveal cardiac tamponade if present

Radiology

• chest X-ray may be helpful
• computed tomography shows pericardial air
• barium swallow may show esophageal fistula

Management

• consult cardiology
• if signs of cardiac tamponade
  • pericardiocentesis
  • pericardial catheter should be left in place to prevent recurrence

More general terms

• pericardial disease
• pneumothorax