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  • Title: Benign pneumopericardium and tamponade.
    Author: Hadjis T, Palisaitis D, Dontigny L, Allard M.
    Journal: Can J Cardiol; 1995 Mar; 11(3):232-4. PubMed ID: 7889442.
    Abstract:
    A 49-year-old obese female was admitted for acute onset pleuritic chest pain. Previous history was significant for surgical correction of a lower esophageal ring. Echocardiography revealed a pericardial effusion, which resolved with steroids. One week later, the patient complained of similar symptoms. Physical examination was consistent with tamponade, while a Hammond crunch was noted over the sternum. Chest x-ray revealed a pneumopericardium. Operative findings consisted of an intrathoracic stomach, a greater curvature ulcer that had perforated the pericardium and a mediastinal abscess. A pericardial window was created, a drain was placed and the perforated ulcer was repaired. Postoperative course was complicated by fever and gastrointestinal bleeding. The patient died suddenly on the 30th postoperative day. Autopsy revealed a massive pulmonary embolus, bleeding esophageal ulcer, healed gastric ulcer and serofibrinous pericarditis. This case illustrates that, while the immediate treatment of tension pyopneumopericardium is usually successful, postoperative mortality remains elevated.
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