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      Spontaneous pneumopericardium an unusual complication in a patient of HIV and pulmonary tuberculosis

      case-report

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          Abstract

          Pneumopericardium is defined as a collection of air or gas in the pericardial cavity. It is a rare entity and spontaneous pneumopericardium is even rarer. It is a rare complication of tuberculosis and human immunodeficiency virus and just three cases have been reported so far.

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          Spontaneous Pneumopericardium: Case Report and Review of the Literature

          An 84-year-old man presented with acute dyspnea and chest pain attributed to his long medical history of cardiorespiratory problems. Admission chest roentgenogram revealed a moderate pneumopericardium and a cavitary lesion in the base of the right lung. The lesion was found to be a bronchogenic carcinoma perforating through the upper pericardium to form a bronchopericardial fistula, confirmed by autopsy. A review of the literature concerning the various causes of pneumopericardium, the clinical features and the principles of treatment is included.
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            Pneumopericardium--complication of an unknown tuberculosis in a HIV positive patient.

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              Spontaneous pneumopericardium in acute asthma

              A 14-year-old girl presented with sudden onset breathlessness associated with swelling over the face, chest and upper limbs. The breathlessness developed after a single bout of cough and progressed within a few minutes. On examination the patient was breathless with a pulse rate of 112 bpm, blood pressure of 106/76 mmHg, respiratory rate of 35 breaths/min and was afebrile. The face, chest and upper limbs were swollen and crepitus was felt on palpation. The trachea was in the midline. Air entry was reduced on the left side and diffuse wheezing was present. An immediate chest roentgenogram was done which revealed subcutaneous emphysema, mediastinal emphysema and a left pneumothorax. A lateral view revealed pneumopericardium (Fig. 1). The patient was managed conservatively with high flow oxygen, antibiotics, bronchodilators and corticosteroids. The patient improved and was discharged a week later. Fig. 1 Lateral chest x-ray showing pneumopericardium The phenomenon of pneumomediastinum (air in the mediastinum), pneumopericardium (air in the pericardium) and subcutaneous emphysema can result from many intrathoracic causes. The mechanism involves alveolar rupture secondary to raised intrathoracic pressures also called the Macklin effect [1]. Other than acute asthma, pneumopericardium can accompany a number of conditions including mechanical ventilation in neonates, thoracic trauma, following cardiac surgery, fistula formation from oesophageal or gastric ulcers, or even during labour [2]. Although chest radiography helps in the diagnosis of pneumopericardium and pneumomediastinum, computed tomography (CT) helps in confirming the presence of air [3]. Pneumopericardium is usually self-limiting but features of tamponade may necessitate pericardiocentesis. It is important that clinicians are aware of this rare but potentially fatal complication of asthma.
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                Author and article information

                Journal
                Lung India
                Lung India
                LI
                Lung India : Official Organ of Indian Chest Society
                Medknow Publications & Media Pvt Ltd (India )
                0970-2113
                0974-598X
                Apr-Jun 2013
                : 30
                : 2
                : 148-150
                Affiliations
                [1] Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
                [1 ] Department of Pulmonary Medicine, DMC and H, Ludhiana, Punjab, India
                Author notes
                Address for correspondence: Dr. Vishal Chopra, 27, Bank Colony, Patiala, Punjab, India. E-mail: drvishalchopra@ 123456hotmail.com
                Article
                LI-30-148
                10.4103/0970-2113.110425
                3669556
                23741097
                d069ceb6-6fd0-4e97-8e6e-c293a1d543d7
                Copyright: © Lung India

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Respiratory medicine
                hiv,pneumopericardium,tuberculosis
                Respiratory medicine
                hiv, pneumopericardium, tuberculosis

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