Iatrogenic Pneumopericardium After Pericardiocentesis: A Systematic Review and Case Report

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Pneumopericardium, defined as air in the pericardial cavity, can arise as an iatrogenic complication.
• This study focuses on pneumopericardium following pericardiocentesis, particularly in a patient with primary cardiac angiosarcoma.
• A systematic review evaluates associated pneumopericardium and the diagnostic utility of echocardiography.

Purpose of the Study:

• To provide a comprehensive overview of iatrogenic pneumopericardium post-pericardiocentesis.
• To evaluate the role of echocardiography in diagnosing this complication.
• To analyze case reports and identify common causes and management strategies.

Main Methods:

• Systematic review of PubMed database (inception-January 2025) following PRISMA guidelines.
• Inclusion of English-language articles on iatrogenic pneumopericardium after pericardiocentesis.
• Appraisal of 37 selected case reports using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

Main Results:

• 37 patients from 37 articles were included; moderate overall quality of case reports.
• 51.6% of patients experienced hemodynamic compromise or cardiac tamponade.
• Catheter drainage system issues were the primary cause; 64.9% required decompressive therapy.

Conclusions:

• Pneumopericardium is a recognized complication of pericardiocentesis and should be considered in symptomatic patients.
• Transthoracic echocardiography has limitations in detecting pneumopericardium.
• Chest X-ray and computed tomography are definitive diagnostic tools.