Tension pneumopericardium caused by positive pressure ventilation complicating anaerobic pneumonia.
A 22-year-old man was admitted with pneumonia. He was immediately intubated and positive pressure ventilation was initiated. Blood and sputum cultures showed Bacteroides fragilis and Corynebacterium sp., which were treated with metronidazole and clindamycin. Three weeks later his blood pressure suddenly dropped with an elevation of the central venous pressure. Chest X-ray revealed a pneumopericardium. A parasternal mediastinotomy with partial pericardiectomy was immediately performed. On opening the pericardium his blood pressure normalised. The patient gradually recovered and six weeks after admission he was extubated. Two weeks later he was discharged. A pneumopericardium without previous thorax trauma is very rare and early recognition is imperative because a tension pneumopericardium with cardiac tamponade may develop, as happened in this case. A tension pneumopericardium has to be treated with immediate pericardiocentesis followed by partial pericardiectomy to avoid recurrence.
Department of Internal Medicine 541, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. C.Bleeker-Rovers@nucmed.umcn.nl
C P
CP
Bleeker-Rovers
F J J
FJ
van den Elshout
T I F M
TI
Bloemen
H A H
HA
Kaasjager
D000328:Adult; D001442:Bacteroides Infections / Q000150:complications* / Q000188:drug therapy; D001441:Bacteroides fragilis / Q000302:isolation & purification; D002305:Cardiac Tamponade / Q000209:etiology* / Q000601:surgery; D002981:Clindamycin / Q000627:therapeutic use; D003352:Corynebacterium / Q000302:isolation & purification; D003354:Corynebacterium Infections / Q000150:complications* / Q000188:drug therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000009:adverse effects*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D010492:Pericardiectomy / Q000379:methods; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000188:drug therapy; D011026:Pneumopericardium / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome
D008795:Metronidazole; D002981:Clindamycin