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Spontaneous tension pneumopericardium.

Stephen H Boyce¹, Alasdair R Corfield, A Crawford McGuffie

¹Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland, UK. steveboyce_scotland@yahoo.com

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine

|May 29, 2004

Summary

A man with a history of stab wound developed chest pain due to a diaphragmatic hernia. A perforated gastric ulcer allowed air into the pericardial sac, treated successfully with needle pericardiocentesis.

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Area of Science:

Gastroenterology
Thoracic Surgery
Emergency Medicine

Background:

A 29-year-old male with a history of intravenous drug abuse and prior laparotomy presented with acute chest and upper abdominal pain.
The patient had a history of a stab wound to the left hypochondrium, indicating potential for diaphragmatic injury.

Observation:

Initial presentation included distress, grunting respiration, and a pneumopericardium on chest X-ray.
Clinical deterioration with increased dyspnea and agitation was noted, with repeat X-ray showing increased pneumopericardium.
Needle pericardiocentesis provided rapid clinical improvement, suggesting decompression was effective.

Findings:

A water-soluble contrast swallow revealed a diaphragmatic hernia and contrast in the pericardial sac.

Related Experiment Videos

Surgical exploration confirmed a pre-existing diaphragmatic defect and a perforated gastric ulcer.

The gastric ulcer communicated directly with the pericardial sac, explaining the pneumopericardium.

Implications:

This case highlights a rare complication of diaphragmatic injury and gastric ulceration.
Prompt diagnosis and intervention, including pericardiocentesis and surgical repair, are crucial for patient survival.
Understanding the sequelae of penetrating trauma is essential for managing complex abdominal and thoracic emergencies.