Pitfalls in Diagnosing a Tension Pneumopericardium—A Case Report

Shankar Hanamantrao Hippargi, Vinayak Tonne

Department of Accident & Emergency Medicine, Meenakshi Mission Hospital & Research Center, Madurai, India.
Department of Imaging Science, Medwin Multispecialty Hospital, Hyderabad, India.

DOI: 10.4236/ijcm.2013.44036                

Abstract

A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable; however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.

Keywords

Tension Pneumopericardium; Cardiac Tamponade; Traumatic Pneumopericardium; Pneumo-Tamponade; Small Heart Sign

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	T. G. Buchman, B. L. Hall, W. M. Bowling, G. D. Kelen, et al., Eds., “Thoracic Trauma,” In: Judith Tintinalli’s Emergency Medicine—A Comprehensive Study Guide, 6th Edition, McGraw-Hill, New York, 2004, p. 1595
[2]	R. G. Cummings, R. L. R. Wesly, D. H. Adams and J. E. Lowe, “Pneumopericardium Resulting in Cardiac Tamponade,” The Annals of Thoracic Surgery, Vol. 37, No. 6, 1984, pp. 511-518.
[3]	J. M. Douglas Jr., “The Pericardium,” In: Sabiston & Spencer’s Surgery of the Heart, 6th Edition, Saunders, Philadelphia, 1996, pp. 1378-2379
[4]	D. H. Spodick, “Pericardial Diseases,” In: Braunwald Zipes Libby’s Heart Disease—A Textbook of Cardiovascular Medicine, 6th Editon, HIE Saunders, Philadelphia, 2001, p. 1832.