A peculiar extra heart sound after artificial pneumothorax in congenital pericardial defect: a diagnostic clue

A 37-year-old man was admitted to the hospital in order to evaluate the cause of systolic ejection heart murmur and to treat his easy fatigability. The chest roentgenogram showed a marked protrusion of the left second and third arches of the cardiac silhouette. At the diagnostic procedure, 200 ml of air was injected into the left thoracic space. The chest roentgenogram revealed no sign of pneumopericardium, but an abnormal extra heart sound was audible. Addition of another 200 ml of air was needed to reveal a pneumopericardium on the chest roentgenogram. A peculiar extra heart sound after artificial pneumothorax may be useful for the early recognition of congenital pericardial defect.