Traumatic Pneumopericardium-Case Report and Review of Literature

Introduction: Pneumopericardium is a rare entity that is defined as the collection of air within the confines of the pericardial sac. It is seen as a consequence of chest trauma or mechanical ventilation. Presentation of case: A 55-year-old man was admitted to The Canberra Hospital following a collision between a bus and a pushbike. He sustained head, chest and abdominal injuries. An unusual feature of his chest injury was the presence of a pneumopericardium. Discussion: Pneumopericardium is associated with 58% mortality even in the absence of a tamponade and 37% will develop a tension pneumopericardium. There are no clearly accepted management guidelines for the treatment of this rare condition. Intervention is guided by clinical and radiographic features of haemodynamic compromise with all cases otherwise managed by close observation. Conclusion: The available published literature on pneumopericardium is scant, and accordingly, incidence rates of this condition remain unclear. In particular, clinical trials investigating the optimal management of this pathological entity are non-existent. It is crucial to recognize that though a relatively benign condition at times, it is a serious complication of trauma with potentially fatal consequences. An all-inclusive approach to management is crucial with judicious intensive care management coupled to early and appropriate imaging and serial reassessments.