Citation

Hagiwara S, Ogino T, Isaka A, Ihara N, Nakamura M, Nameki T, Takahashi Y, Iino Y. Inj. Extra 2007; 38(12): 436-438.

Affiliation

Dept of Emergency Medicine, Gunma University, Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan (ZAP14075@yahoo.co.jp)

Copyright

(Copyright © 2007, Elsevier Publishing)

DOI

10.1016/j.injury.2007.03.006

PMID

unavailable

Abstract

Pneumopericardium in adults is unusual but can occur in the context of severe blunt chest trauma, pneumothorax, pneumoperitoneum or another cause of pneumomediastinum. Tension pneumopericardium is a haemodynamically unstable condition caused by the presence of air in the pericardial space and requires immediate pericardiocentesis to stabilise the patient. This condition is easily diagnosed by the 'flat heart sign' on a computed tomography scan of the thorax and abdomen.

In 1995, Capizzi reviewed reports about pneumopericardium caused by blunt injury, finding that 12 of 32 patients developed unequivocal tamponade from tension pneumopericardium. We report a case of haemodynamically unstable tension pneumopericardium that occurred following a motor vehicle accident.

Several mechanisms have been proposed to explain the development of tension pneumopericardium after chest trauma. These mechanisms include: (1) Increased intra-alveolar pressure rupturing the alveolar walls and so allowing air to dissect the peribronchial-vascular sheaths and enter the mediastinum. (2) Positive-pressure ventilation forcing air along the perivascular sheaths into the pericardium. Thus, a one-way valve mechanism may develop in the pericardium, so that air can go into but not out of the pericardial sac. (3) Rupture of the trachea resulting in the direct communication with the pericardial sac, with potential valve mechanisms. (4) Direct communication between a tension pneumothorax and the pericardial space.