Benign pneumopericardium and tamponade.
A 49-year-old obese female was admitted for acute onset pleuritic chest pain. Previous history was significant for surgical correction of a lower esophageal ring. Echocardiography revealed a pericardial effusion, which resolved with steroids. One week later, the patient complained of similar symptoms. Physical examination was consistent with tamponade, while a Hammond crunch was noted over the sternum. Chest x-ray revealed a pneumopericardium. Operative findings consisted of an intrathoracic stomach, a greater curvature ulcer that had perforated the pericardium and a mediastinal abscess. A pericardial window was created, a drain was placed and the perforated ulcer was repaired. Postoperative course was complicated by fever and gastrointestinal bleeding. The patient died suddenly on the 30th postoperative day. Autopsy revealed a massive pulmonary embolus, bleeding esophageal ulcer, healed gastric ulcer and serofibrinous pericarditis. This case illustrates that, while the immediate treatment of tension pyopneumopericardium is usually successful, postoperative mortality remains elevated.
Hadjis
T
T
Department of Cardiology, Hôpital du Sacré-Coeur, Université de Montéal, Québec.
Palisaitis
D
D
Dontigny
L
L
Allard
M
M
D002305:Cardiac Tamponade / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications* / Q000209:etiology; D011026:Pneumopericardium / Q000209:etiology*; D013270:Stomach / Q000002:abnormalities; D013276:Stomach Ulcer / Q000150:complications*; D013492:Suppuration