[An 80-year-old female with pneumopericardium due to gastric perforation]

An 80-year-old woman was admitted to our hospital because of chest oppression and general malaise. On admission, auscultation of the heart revealed friction rub, so-called water-wheel like murmur. Chest X-ray film and computed tomography showed cardiomegaly and free air in the pericardium. Electrocardiogram showed low voltage with ST elevation in II, III, aVF and V1-V4. These findings suggested that the patient had pneumopericardium with pericarditis. Wenchebach type A-V block and atrial bradycardia appeared. Thus, the ventricular pacing was performed. However, patient died of multiple organ failure. The postmortempericardiography showed the gastro-pericardial fistula with hiatus hernia.