PYOPNEUMOPERICARDIUM: A CASE OF A BRONCHO-PERICARDIAL FISTULA FROM A CAVITARY LUNG MASS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pneumopericardium, or air in the pericardial space, most often results from associated trauma. Less commonly, it is with disease processes contiguous organs. Rare cases of tension pyopneumopericardium have been described (1). CASE PRESENTATION: A 57-year-old female a history an enlarging cavitary lung lesion unknown etiology for one year, complicated by recurrent P. Aeruginosa pneumonia presented to emergency room acute on chronic chest pain and shortness breath. On admission, she was toxic appearing decreased breath sounds over left field tachycardic. Initial laboratory evaluation showed WBC 19K 87% neutrophils lactic acidosis 2.6. CT scan noted previously mass hemithorax measuring 10 x 7 9 cm effusion up 2.9 cm. Blood cultures grew MDR which started appropriate antibiotics. hospital day 2, developed atrial fibrillation transferred cardiac intensive care unit. While undergoing urgent pericardiocentesis demonstrated frank pus, experienced massive hemoptysis subsequent arrest requiring mechanical ventilation. Pericardial fluid also Aeruginosa. 8, drain frequent emptying. The patient subsequently tamponade physiology increasing vasopressor requirements accumulation drain. Review fistulous tract pericardium. Given patient's poor prognosis, family elected withdraw care. Pathology wall biopsy yielded poorly differentiated squamous cell carcinoma. DISCUSSION: limited number as cause pneumopericardium described. To our knowledge, there no carcinoma pericarditis. Tension emergent condition. Prompt recognition, surgical intervention antimicrobial therapy important patients pyopneumopericardium, though unfortunately majority documented resulted mortality (2). In above-described patient, following ventilation leading rapid clinical deterioration. her advanced state, therapeutic interventions were at time diagnosis. These complications are unavoidable setting when require procedures interventions. CONCLUSIONS: This case illustrates outcomes difficult task early recognition multiple medical conditions. REFERENCE #1: Cummings RG, Wesly RLR, Adams DH, Lowe JE. Pneumopericardium resulting tamponade. Annals Thoracic Surgery. 1984;37(6):511-518. doi:10.1016/s0003-4975(10)61146-0 #2: Miller Wayne L, Osborn Michael J, Sinak Lawrence Westbrook Benjamin M. Pyopneumopericardium Attributed Esophagopericardial Fistula: Report Survivor Literature. Mayo Clinic Proceedings. 1991;66(10):1041-1045. doi:10.1016/s0025-6196(12)61728-5 DISCLOSURES: No relevant relationships Mehnaz Ali Khan, source=Web Response Flanagan, Aditya Kasarabada, Spencer Schrank, Vaughan Washco,