The Image of Trauma
The Journal of TRAUMA威 Injury, Infection, and Critical Care
Pneumopericardium After Major Trauma Alessandro Di Filippo, MD, Stefano Batacchi, MD, Marco Ciapetti, MD, Rosario Spina, MD, and Adriano Peris, MD
J Trauma. 2009;66:1260.
ension pneumopericardium is observed with pneumothorax (PNX) after major trauma.1 The suggested treatment is the direct aspiration of pericardium or the conservative treatment because it usually resolves spontaneously. We describe a case of tension pneumopericardium resolved with the positioning of a chest tube drainage after a first failed temptation.
CASE REPORT A 20-year-old male, after falling from 15 meters, reported a major trauma that consisted with hemorrhagic shock, PNX and pneumopericardium, lung contusions, retroperitoneal bleeding, lumbar vertebral fractures, leg and arm multiple fractures. The patient, in emergency room, was intubated and submitted to first-line diagnostic evaluation for major trauma that revealed a negative for intra-abdominal bleeding FAST, and a negative for PNX thorax Rx. Because an episode of hypotension and hypoxemia with reduction of breathing sound in right thorax, a chest drainage tube was inserted in midclavear line on the second intercostal space. The maneuver was successful and the symptoms were reduced. But, during computed tomography scan evaluation, the patient developed a new hypotension, hypoxemia, edema and cyanosis of the neck and superior thorax, and jugular veins over distension. The computed tomography scan of thorax revealed a tension PNX and pneumopericardium (Fig. 1). Therefore, the physician inserted a tube in the fifth intercostals space in axillary line that resolved the PNX and the pneumopericardium too (Fig. 2).
Fig. 1. Tension PNX and pneumopericardium in a patient with major trauma.
DISCUSSION In this case, the resolution of PNX was effective also on the pneumopericardium and on the related symptoms. This evolution suggests that a communication between the two viscera has been caused by the trauma and that the air had passed under tension in the pericardium. Submitted for publication December 18, 2006. Accepted for publication January 12, 2007. Copyright © 2009 by Lippincott Williams & Wilkins From the Unit of Anesthesia and Intensive Care of Emergency, Department of Emergency, Careggi Teaching Hospital, Firenze, Italy. Address for reprints: Alessandro Di Filippo, MD, Unit of Anesthesia and Intensive Care of Emergency, Department of Emergency, Careggi Teaching Hospital, viale Morgagni 85, Firenze 50124, Italy; email: [email protected]
Fig. 2. The same patient after drainage with chest tube inserted on the radiologic table.
Therefore, the drainage of PNX could be the initial attempt in case of PNX associated with pneumopericardium in emergent conditions.
Hashmi S, Rogers SO. Tension pneumothorax with pneumopericardium. J Trauma. 2003;54:1254.