Pneumopericardium: a Possible Rare Cause of Neonatal Death

The aim of this paper is to point to the dangers of pneumopericardium (PPC), which is defined as a collection of air or gas in the pericardial cavity. PPC belongs to the most dangerous kinds of extra-alveolar air and only physicians' awareness of that condition and immediate air evacuation (pericardiocentesis) prevents the deleterious results. Neonatal pneumopericardium is a rare clinical condition. We report a case of neonatal pneumopericardium with the fatal outcome, occurring in the presence of significant lung pathology (in utero meconial aspiration, pulmonary hypertension) and a history of neonatal resuscitation. The patophysiological mechanism is the obstruction of large and small airways with the aspirated material and consecutive air trapping distal to obstruction, over distension and rupture of alveolar walls, allowing gas to escape and dissect along perivascular and peribronchial sheaths towards pericardial sac within which this air accumulates. Mechanically ventilated patients are particularly at risk for tension pneumopericardium (TPPC) secondary to barotrauma. Acute cardiac shock, pulsus paradoxus and decreased systolic blood pressure (the heart is ineffectual pump), muffled heart sounds and a metallic sound of high frequency refer to the presence of a pneumopericardium. Tension pneumopericardium is a life threatening condition, so early recognition and intervention (pericardiocentesis) is very important.