pneumopericardium

Infant with
hematemesis who had an unsuccessful nasogastric tube placementCXR AP shows air outlining the heart in the pericardial space, air outlining the thymus in the mediastinum, and air in the bilateral pleural spaces.The diagnosis was pneumopericardium, pneumomediastinum, and pneumothorax due to esophageal perforation from traumatic nasogastric tube placement. A subsequent esophagram did not demonstrate a leak.
pediatricimaging.org • CC-by-nc-sa 4.0
Premature
newborn with respiratory distress on a ventilatorCXR AP (above) shows a large amount of air around the heart. CXR AP obtained after pericardiocentesis (below) shows a decreased amount of air around the heart and the diaphragm can be continuously traced across the image.The diagnosis was pneumopericardium in a patient with respiratory distress syndrome.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
cough and fever. CXR AP and lateral (above) shows right upper lobe collapse and air outlining the inferior border of the heart (continuous diaphragm sign). Left lateral decubitus CXR (below) shows a small right pneumothorax.The diagnosis was pneumopericardium and pneumomediastinum and right pneumothorax in a patient with respiratory syncytial virus pneumonia.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Pneumopericardium represents gas (usually air) within the pericardium, thus surrounding the heart.

Pathology

Etiology

Underlying causes include:

  • positive pressure ventilation
  • thoracic surgery/pericardial fluid drainage
  • penetrating trauma
  • blunt trauma (rare)
  • infectious pericarditis with gas-producing organisms
  • fistula
    • between the pericardium and an adjacent air-containing organ (i.e. stomach or esophagus)

Radiographic features

Plain radiograph and CT

On both chest radiographs and CT, appearances are characteristic, the heart being partially or completely surrounded by gas, with the pericardium sharply outlined by gas density on either side. Continuous diaphragm sign may be present.

Ultrasound

The introduction of a smooth air-soft tissue interface when intra-pericardial air is present results in horizontal reverberation artifacts obscuring the heart, appearing identical to A-lines. The appearance is similar to pneumomediastinum, but may be differentiated by the following features;

  • heart remains obscured throughout the cardiac cycle
  • involves the subxiphoid window
    • characteristically spared in pneumomediastinum

Treatment and prognosis

Complications

Differential diagnosis

A pneumopericardium can usually be distinguished from pneumomediastinum since gas in the pericardial sac should not rise above the anatomic limits of the pericardial reflection on the proximal great vascular pedicle. Also on radiographs obtained with the patient in the decubitus position, gas in the pericardial sac will shift immediately, while gas in the mediastinum will not shift in a short interval between films.

Occasionally, it may not be possible to distinguish pneumopericardium from pneumomediastinum on plain radiographs.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Pneumoperikard:
Mediastinalemphysem
 
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