Iatrogenic pneumopericardium in the setting of carcinomatous
The present case has been reported in BMJ.

A 74-year-old woman with no remarkable medical history reported lower extremity oedema for 4 months before visiting our hospital. She presented with breathing difficulty at admission and subsequently reported coughing and paroxysmal nocturnal dyspnoea 1 month prior to admission. Chest radiography revealed cardiac dilation and bilateral pleural effusion.

Chest and abdominal CT and PET revealed nodules and enlargement of the right paratracheal lymph node in the right lung, abdominal lymphadenopathy, and pericardial and pleural accumulations of fluid. Adenocarcinoma was detected during pleural effusion examination. The patient was diagnosed with cT2aN3M1b stage IV pulmonary primary adenocarcinoma following a bronchoscopic examination.

Cardiac tamponade was suspected based on a systolic blood pressure of 90 mm Hg, pulse of 120 bpm and oxygen saturation of 90% on room air; therefore, a cardiac puncture without continuous suction was performed.

Following puncture, the radiolucent pockets representing air appeared on chest radiography in the same location from which the pericardial effusion had been removed. Chest CT image showed air fluid level within the pericardial sac and the absence of any fistulous tracts between the pericardium and trachea/airways. Additionally, cytological analysis of the pericardial fluid revealed adenocarcinoma cells. These findings are consistent with pneumopericardium on a background of carcinomatous pericarditis.

Learning points
• Pneumopericardium is the accumulation of gas in the pericardial cavity. It is most commonly caused by direct trauma to the pericardial layer surrounding the heart.

• Iatrogenic pneumopericardium as a consequence of pericardiocentesis is rare. However, meticulous procedural technique and postprocedure monitoring including chest radiography are necessary.

Read in detail here: http://casereports.bmj.com/content/2018/bcr-2018-227270.full
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Dr. S●●●●●●m H●●●●●●r
Dr. S●●●●●●m H●●●●●●r General Medicine
A rare case presented very nicely.
Nov 13, 2018Like